HOMOEOPATHIC MANAGEMENT IN DEPRESSION · HOMOEOPATHIC MANAGEMENT IN DEPRESSION DR. RABIYA BASHRI MD(Hom) Department of Materia Medica, H.K.E.’S Homoeopathic Medical College & Hospital
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HOMOEOPATHIC MANAGEMENT IN DEPRESSION
DR. RABIYA BASHRI MD(Hom)Department of Materia Medica,
H.K.E.’S Homoeopathic Medical College & HospitalGulbarga, Karnataka
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ACKNOWLEDGEMENT
First and foremost, I am thankful to God Almighty for bestowing
upon me patients, health and fortitude to complete this work and parents
Mrs. Beejani Guarantee and MR. Maheboob Sab Guarantee, for their silent
sacrifices, constant encouragement, forbearance, blessing, their loving
interest and inspiration every step and stage of my educational career,
without this work could not have seen the light of the day.
My husband Mr. Qasim for permitting me.
My special thanks to my far relative Grandmother Maheboobee for
looking after my children during my dissertation work and for her kind help
and Maternal Uncle Mr. Shaikh Meera for his encouragement.
I express my deep sense of gratitude to Dr. Rajeshwari. Kinagi,M.D.(HOM)
Guide, Professor and head, Dept. of Materia Medica, for guidance kind
co-operation, good suggestion, novel comments and giving me freedom
to pursue my work. I thank her for providing me this opportunity to work
under her supervision.
It gives me great pleasure to express my sincere gratitude to
Dr. Sampath. Rao, M.D.(HOM) Principal, Professor and Head, of Organon of
Medicine and Homoeopathic philosophy, for his valuable suggestions
during the course.
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Special thanks to P.G coordinator Dr. Ashok. Patil, M.D.(HOM) Professor and
Head, Dept of Medicine and Repertory, for his valuable suggestions
during the course.
I thank Dr. Vijay Laxmi B.M. M.D.(HOM), Head, Dept of Obstetric and
Gynecology, Dr. S.S. Jambaladinni M.D.(HOM), Head, Dept of Pharmacy and
Dr. S.Krishna M.D.(HOM), Professor, Materia Medica. Dept of Repertory for their
kind help.
I express my thanks to the Management of HKE’S Homoeopathic
Medical College and Hospital, GULBARGA, for giving me an
opportunity to study.
I express my special thanks to the Management of A.M. Shaikh
Homoeopathic Medical College and Hospital, Belgaum, for help,
giving me an opportunity to work and acquire varied knowledge in the
theory and practice of Homoeopathy.
Gives me an immense pleasure to thank Dr.M.A.Udachankar Principal,
Professor and Head, Dept of Materia Medica, A.M.Shaikh Homoeopathic
Medical College Belgaum for being my teacher, and for his kind
cooperation.
It gives me a great pleasure to thank Late.Dr.V.D.Raravi. P.G
coordinator, Professor and Head, Dept of Organon of Medicine and
Homoeopathic Philosophy, A.M.Shaikh Homoeopathic Medical College
and Hospital Belgaum for his help and guidance.
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I would like to place an record my special thanks to Dr.Sucheta
Waghamare, Psychiatrist, Civil Hospital Belgaum, for allowing me to work with
her, and her valuable guidance during my work.
I also thank Dr.G.R. Mohan and Dr. Janardhan Reddy, for their help.
Words cannot suffice to express my gratitude to my sisters
Mrs.Julekha Shaikh Hussain and Mrs.Ashmat Farooq Sayyed, brothers Ibrahim,
Maqbul, Azmeer, Ameer, Azhar, and my lovely sweet children Muhd.Ismaeel,
Muhd.Muzammil for the care and affection that they have showered upon
me. They were my indomitable pillars of support and strength through the
course of this study. I shall cherish my association with them forever.
Thanks Dr. Prabhakar J. Jaybhave for his help.
I shall be failing in my duties if I do not Acknowledge with a deep
sense of gratitude the cooperation of all my patients.
I express my thanks to Miss. Veena & Deepak of Sai Xerox &
Computer for Typing this dissertation and binding.
Dr. Rabiya Bashri Date:
Place: Gulburga
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ABBREVIATIONS
C.C.F. = Congestive Cardiac Failure
Diabetes M. = Diabetes Mellitus
F = Father
H.Wife = House wife
HTN = Hypertension
M = Mother
MGF = Maternal Grand Father
MGM = Maternal Grand Mother
Psoro-Syco = Psoro-Sycotic
Sis = Sister
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ABSTRACT
HOMOEOEPATHIC MANAGEMENT OF “DEPRESSION”
Background and Objectives
Depression is one of the form of mood disorder characterized by
predominant disturbance in mood. The first 3 editions of the Diagnosis
and statistical manual of mental disorder published by the American
Psychiatric Association (DSM-I, II, III) use the term “Affective
disorder” to describe disturbance in mood. The revised third edition
(DSM-III-R) which is presently in uses, substituted mood, disorder in
place of “Affective disorder”. Susceptible or predisposed persons
exposed to stress in any form physical, psychological or psychosocial
precipitates the illness. Anti-depressive, drugs not to be continued
more than 3 weeks develops tolerance, habituation addiction or
psychosis. Drugs tried for psychoneurosis may have temporary effect,
effect last for few hours.
In Homoeopathy the psychic treatment will perhaps bring down
the number of suicidal to half.
By definition Depression is one of the form of mood disorder
characterized by predominant disturbance in mood. Clinically
significant depression is often referred to major depressive disorder. It
has somatic as well as psychological symptoms means that it may be
difficult to distinguish from a medical condition. In cases of doubt it is
helpful to seek the psychological. Symptoms of depression. Criteria for www.similima.com Page v
major depressive episode, source-diagnostic and statistical manual of
mental disorder, 4 t h edition.
Objectives
1. To assess the role of Homoeopathic remedies in treatment of
depressed women with family stressors.
2. To treat the disorder by selecting the constitutional remedy on
basis of totali ty of symptoms.
3. To reduce recurrent attack and relapses.
4. Counselling and rehabili tation of women.
Methods
The present study consisted 30 patients of Depression, who
attended my clinic during the period of 29-10-2003 to 31-03-2005.
30 cases of depression were selected on the basis of
inclusion criteria, which are all females
Females of reproductive age group were considered from
menarche to menopause.
Diagnosis of depression where made on following points.
Basic and absolute manifestation with determinative
symptoms of the disease (as per ICD-10 classification of mental
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disorder) and criteria for major depressive episode (Source-
Diagnostic and statistical manual of mental disorder, 4 t h edition).
Determinative symptoms of an individual on the basis of
totali ty of symptoms.
Miasmatic diagnosis done.
Selection of remedy was done on the basis of repetorial
results, characteristic symptoms and miasmatic diagnosis of the
patient.
Results
Out of 30 cases 26 cases improved, 2 cases not improved and 2
cases discontinued.
Interpretation and Conclusion
I arrived at the conclusion that Homoeopathic Management of
Depression in females with family stressors along with
counseling and psychotherapy has shown tremendous result in
most of the cases taken for my study.
After prescribing indicated remedy patient started improving
mentally and physically, as the prescribed remedy has reduced
episodes, unnecessary imaginative process come unnecessary in
mind.
Hence she started feeling better, sense of well being is also
followed by.
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Indicated Homoeopathic remedy after prescribing created
awareness to the patient that she is unnecessarily over reacting to
the situation around her, and also Homoeopathic indicated
remedies will minimize negative reactions to all exposures like
mental stress.
The Homoeopathic medicines seems to be efficacious in reducing
recurrence and bring about significant improvement.
Key Words
Depression; Mood disorder; Affective disorder; Unipolar; Major
Depression; Stress; Suicide; Melancholia; Councelling;
Psychotherepy.
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TABLE OF CONTENTS
S.NO. TOPIC PAGE NO.
1. INTRODUCTION 1-3
2. OBJECTIVES 4
3. REVIEW OF LITERATURE
5-110
4. METHODOLOGY 111-116
5. RESULTS 117-128
6. DISCUSSION 129-134
7. CONLUSION 135
8. SUMMARY 136-138
9. BIBLIOGRAPHY 139-145
10. ANNEXURES
Performa-I 146-170
Graphs-II 171-178
Master Chart-III 179-180
Synopsis of Cases-IV 181-193
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LIST OF TABLES
S.NO. TABLES PAGE NO.
1. Age Incidence 117
2. Area wise Incidence 118
3. Occupation 118
4. Types of Family 119
5. Economic Background 119
6. Education 120
7. Type of Marriage 120
8. Marital Relations 121
9. Past History 122
10. Family History 123
11. Types of Depression 124
12. Miasmatic Background 125
13. Constitutional Remedies 126
14. Complementary Remedies 127
15. Intercurrent Remedies 127
16. Result of Treatment 128
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LIST OF FIGURES S.
NO.FIGURES PAGE
NO.
1. Chart showing Age Incidence 171
2. Chart showing Area wise Incidence
171
3. Chart showing Occupation 172
4. Chart showing Types of Family 172
5. Chart showing Economic Background
173
6. Chart showing Education 173
7. Chart showing Type of Marriage 174
8. Chart showing Marital Relations 174
9. Chart showing Past History 175
10. Chart showing Family History 175
11. Chart showing Types of Depression
176
12. Chart showing Miasmatic Background
176
13. Chart showing Constitutional Remedies
177
14. Chart showing Complementary Remedies
177
15. Chart showing Intercurrent 178
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Remedies
16. Chart showing Result of Treatment
178
INTRODUCTIONAPI 1 Depression is one of the form of mood disorder
characterized by predominant disturbance in mood. The first 3
editions of the Diagnostic and Statistical manual of mental disorder
published by the American Psychiatric Association (DSM-I, II, III)
used the term “Affective disorder: to describe disturbance in mood.
The revised third edition (DSM-III-R) which is presently in uses,
substituted Mood Disorder in place of “Affective disorder”.
The prevalence of depressive disorder in general medical
practice estimated 5-25% incleinted in rural primary health care clinic
20% Severe, 43% mild.
Harrison’s 2 , approximately 15% of the general population
experiences major depression. Melancholic, anxious, obsessional
personalities are more prone to this illness. History of stressful
environmental factors more often reactive type than endogeneous
type.
Dr. L.P. Shah, Dr. Mrs. Hema Shah, 3 susceptible or
predisposed persons exposed to stress in any form physical,
psychological or psychosocial precipitates the illness. Anti depressive
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drugs not to be continued more than 3 weeks develops tolerance,
habituation, addiction or psychosis.
J.A. Hadfeild 4 , drugs tried for psychoneurosis may have
temporary effect, effect last for few hours.
As world advances mental stress get advances especially in
women who undergo family stressor for any reason or the other, by
constantly undergoing stress and strains land in severe depression and
suicidal tendency. As it is an era of competition, persons has to
struggle to fulfill his needs and requirements. Disappointment in
fulfilling needs and requirements leads to stress. A depressed patient
gets into mental triples, cannot cope up with things causes negative
attitude which leads to disorders.
Melancholia is a disease characterized by great mental
depression. Melancholia a Greek word means “Black and Bile”. The
name founded upon the theory of humeral pathology.
Jean Pierre Gallavardin 5 , in Homoeopathy the psychic
treatment will perhaps bring down the number of suicidal to half. In
fact every time among all ancient and modern people medicinal
substance were used and are still used for psychic treatment but in
less scientific way more often with unconscious, with good primary
action but worst secondary action. The Homeopaths do not use much
the primary effect of medicine of psychic treatment which is always
very temporary but their secondary effect having some time indefinite
persistence.
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Dr. Hahnemann while experimenting healthy man was able to
recognize their affection character and intelligence i.e. to say their
psychic effect.
Present literature, which has explained its importance and
management of such disorder needs a detail study for further
understanding and better management by Homoeopathy.
The present study comprises systemic approach for evolving
Constitutional treatment. It also prove the role of Homoeopathy in
prevention of its complications and recurrences prevention of
antidepressant side effects.
OBJECTIVES
1. To assess the role of homoeopathic remedies in treatment of
depressed women with family stressors.
2. To treat the disorder by selecting the constitutional remedy on
basis of totali ty of symptoms.
3. To reduce recurrent attacks and relapses.
4. Counselling and rehabili tation of women.
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REVIEW OF LITERATURE
HISTORY OF MOOD DISORDERS:(DEPRESSION)
Niraj Ahuja 6 Mood disorders have been known to man since
antiquity. The old Testament describes King Saul as suffering from
severe depressive episodes responding slightly to David’s soothing
music. While Hippocrates coined the words mania and melancholia, it
was Aretaeus who first described mania and depression occurring in
the same individual.
Emil Kraepelin, borrowing from the work of Kahlbaum, Falret
and Baillarger, described the maniac-depressive illness as separate
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from dementia precox on the basis of course, clinical symptoms and
outcome.
Recently, the World Health Report 2001 (WHO) has identified
unipolar as the 4 t h cause of DALY (Disability-Adjusted Life Years) in
all ages, and the 2 n d Cause in 15-44 years. Unipolar depression is also
the 1 s t Cause of YLD (Years of Life Lived with Disability) in all ages.
The comparison was with all medical disorders, and not only
psychiatric disorders.
The WHR-2001 estimates that there are 121 million people
worldwide suffering from depression.
James C. Coleman 7 The great Greek Physician Hippocrates
classified all mental disorders into three broad categories:
1) Mania
2) Melancholia
3) Phrenitis
His description melancholia base on clinical records of his
patients, are strikingly similar to modern clinical symtomatology. The
sixth-century physician Alexander Trallianus was perhaps the first
person to recognize, recurrent cycles of mania and melancholia I
the same persons, thus anticipating by several hundred years
Bonet’s (1684) “Folie maniaco- melancolique and Falret’s (1854)
Folie Circulaire”. It remained for Kraepelin, how-ever in 1899, to
introduce the term.
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In practice, Galen followed the Hippocratic method accepting
the doctrine of “HUMOURS” which regarded the body as composed of
‘BLOOD, PHLEGM, YELLOW BILE AND BLACK BILE; these
nomenclatures were changed to ‘SANGUINE, PHLEGMATIC,
MELANCHOLY AND CHOROTIC’ after in the mediveal time.
M.S. Bhatia 8 Hippocrates coined the term ‘malancholia’. Jules
Falret said that patients become depressed and elated in a cyclic
fashion known as la folie circulaire. Kurl Ludwig Kahlbaum said that
these episodes are different stages of the same disease process, which
he called ‘cyclothymia’. Emil Kraepelin concluded that all these mood
disorders are identical in certain ways. He called the underlying
illness ‘Manic depressive psychosis’.
GALLAVERDIN 5 A GLANCE IN THE HISTORY OF THE USES OF THE SUBSTANCES HAVING EFFECT ON THE MIND: (Psychic Treatment)
1) Historian Diodorus of sicily speaks Egyptians used, about 3 to 4
thousand years ago. He calls it “Antidote of anger and of grief”.
Stramonium mixed with opium to weaken to toxic effect.
Homoeopathy teaches us that stramonium could have been alone
sufficient to calm down the anger and grief.
2) Galen cites also Hemlock which causes madness and the witness
of plato admits that some medicines cause the Delerium, mania
dementia, a loss of memory. These remedies used in infinitesimal
dose will cause the opposite effect.
3) Hippocrates prescribe Mandragora in sadness ending in suicide.
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4) Aulus Gelius and Valeria Maxim, relate that the orators of anxiet
times, envious of real glory used to take following the examples
of can made, a dose of Helleborus before the dispute in order to
strengthen the brain, Now-a-days, one takes a cup of coffee for
the same results.
5) Prof. Florence said ancient did not used mineral water for
corrective effect, but they used the water for there plastic effects
and their psychic properties on their character and intelligence.
6) According to Greek people there were two sources near temple of
Trophonius one Mnemos, the water used to strengthening
memory. Other Lethe, weakness the memory
7) Varonus has mentioned a stream called Nous, water increase the
vitali ty and in the island of Ceos a stream of water which made
one stupid. The water of Lyncest, in Thrace, caused mild
intoxication.
8) According to Eudoxius, the water of clitorius caused dislike for
wine.
9) The waters of Hippocrene, catali, inspired poets.
10) Priests used incenses to calm down the anger, genital passion and
develop religious senses.
11) The vapours of Benzoin burning of live charcoal for mad man,
destroys sensitiveness to pain.
12) In 2n d book of “Laws” Plato recommends wine softness the
rudeness of mind and makes it easier to control oneself is just
like the fire melts iron.
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13) Beer produces heaviness of mind and body.
14) Absinth in small doses quarrelsome and wicked.
15) Brandy makes ore angry and aggressive.
16) Aniseed cordial – cloudiness and embarrassment.
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NIRAJ AHUJA 6 MOOD DISORDERS: (Depressive Episode)
The life-time risk of depression in males is 8-12% and in
females is 20-26%, though the life-time risk of major depression or
depressive episode is about 8%. The typical depressive episode is
characterized by following features (which should last for at least two
weeks).
1. Depressed Mood
2. Depressive Ideation/cognitions
3. Psychomotor Activity
4. Physical Symptoms
5. Biological Functions
6. Psychotic Features
7. Suicide
8. Absence of an Underlying Organic Cause
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KAPLAN A. SADOCK 9 . ICD-10 CLASSIFICATION OF MENTAL
DISORDERS:
F32. 0 Mild depressive episode
Without somatic symptoms
With somatic symptoms
F32 .1 Moderate depressive episode
.10 Without somatic symptoms
.11 With somatic symptoms
F32.2 Severe depressive episode without psychotic
Symptoms.
F32.3 Severe depressive episode with psychotic
symptoms.
F32.8 Other depressive episodes.
F32.9 Depressive episode unspecified
F33 Recurrent depressive disorder
F33.0 Recurrent depressive disorder, current episode mild F33.00 Without somatic symptoms
F33.00 With somatic symptoms
F33.1 Recurrent depressive disorder, current episode
moderateF33.10 Without somatic symptoms
F33.11 With somatic symptoms
F33.2 Recurrent depressive disorder, current episode severe without psychotic symptoms
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F33.3 Recurrent depressive disorder, current episode severe
with psychotic symptoms
F33.4 Recurrent depressive disorder, currently in remission
F33.8 Other recurrent depressive disorder.
F33.9 Recurrent depressive disorder, unspecified
F34 Persistent mood (affective) disorders
F34.0 Cyclothymia
F34.1 Dysthymia
F34.8 Other persistent mood (affective) disorders
F34.9 Persistent mood (affective) disorder, unspecified
F38 Other mood (affective) disorders
F38.0 Other single mood (affective) disorders
F38.00 Mixed affective episode
F38.1 Other single mood (affective) disorders
F38.00 Mixed affective episode
F38.0 Other single mood (affective) disorders
F38.10 Recurrent brief depressive disorder
F38.8 Other specified mood (affective) disorders
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DEFINITION:
API1 Depression is one of the form of mood disorder characterized by predominant disturbances in mood. The first 3 editions of he Diagnostic and Statistical manual of mental disorders published by the American psychiatric Association (DSM – I, II, III) used the term “Affective disorders” to describe disturbance in mood. The revised third edition (DSM – III – R) which is presently in used, substituted “Mood disorders” in place of “Affective disorders”.
DAVIDSON’S 1 0 Clinically significant depression is often
referred to major depressive disorder (MDD). It has somatic as well
as psychological symptoms means that it may be difficult to
distinguish from a medical condition. In cases of doubt it is helpful
to seek the psychological symptoms of depression. Particularly loss of
interest in practice depression is under diagnosed. Recent research
suggests that patients who have a major depressive disorder soon after
MI or stroke die sooner than those who do not, even when disease
severity is controlled.
JEAN –PIERRE GALLAVARDIN 5 Emotion can be described as 2 main types,
1) Affect short lined emotional response to an event
2) Mood Lasting and dominant emotional response which colour
the whole psychic life.
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SELDOM HAINES TALCOTT 1 1 Melancholia is a disease
characterized by great mental depression. Melancholia a great
work mean Black and Bile. The name is founded upon the theory
of humeral pathology the four humors, according to ancients,
being blood, phlegm, yellowbile, and blackbile. Guislain gives as a
synonym of melancholia the term phrenalgia, “Brain pain;” Rush,
Tristimania, “Sand Mania”, Esquirol, Lypemania from Greek
“To make Sad”.
KAPLAN & SADOCK 9 Major depression (unipolar) is reported
to be most common mood disorder. It may manifest as a single
episode or as recurrent episodes.
GELDER LOPEZ-ALBOR Jr AND ANDREASON 1 2 The term
depression can variably define an effect, mood state, a disorder or
syndromes or a specific entity. A depressed effect usually occur in
response to a specific situation and is best defined as a relatively
transient state of feeling “depressed”, “sad”, or “blue”.
HARRISON’S 2 Depression is a one of the form of mood disorder characterized by predominant disturbances in mood.
Major depression is defined as depressed mood on daily basis for a minimum duration of 2 weeks. An episode may be characterized by sadness indifferences, apathy irritability and is usually associated change in number of neurovegetative functions including sleep patterns, appetite, weighs motor ejitation retardation fatigue, impairment in concentration and decision making feeling of shame and guilt’s and thoughts death or dying. Patient of endogenous depression have a profound loss of pleasure in all enjoyable activities, exhibit early morning awakening, feel that the dysphoric mood state quantitatively different from
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sadness and often notice a decimal variation in mood. Approximately 15% of the general population experiences a major depressive episode.
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HARRISON’S 2 CRITERIA FOR MAJOR DEPRESSIVE EPISODE:
(Source – Diagnostic and Statistical manual of Mental disorder, 4 t h edition).
A Fine (or more) of the following symptoms have been present during the same and week period and represent change from previous functioning: At least one of the symptom is either 1) Depressed mood or 2) Loss of interest or pleasure. NOTE: Do not include symptoms that are clearly due to a general
medical condition or mood in congruent delusions or Hallucinations.
A) Depressed mood most of the day, nearly every days as indicated by
either subjective report (eg: feels sad or empty) or observation
made by others (eg: appear tearful) Note: In children and
adolescent can be irritable mood.
1. Markedly diminished interest or pleasure in all, or almost
activities most of the days, nearly everyday (as indicated by
either subjective account or observation made by others).
2. Significant weight loss when not dieting or weight gain (eg. A
change of more than 5% of body weight in a month), or
decreased or increase in a appetite nearly everyday. Note: In
children, consider failure to make expected weight gain.
3. Insomnia or hypersomina nearly every day.
4. Pschychomotor agitation or retardation nearly every day
(observable by others, not merely subjective feeling of
restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
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6. Feeling of worthlessness or excessive or inappropriate guilt
(which may be delusional) nearly every day (not merely self-
reproach or guilt about being sick).
7. Diminished ability to think or concentrate or indecisiveness,
nearly every day (either by subjective account or as observed
by others).
8. Recurrent thoughts of death (not just fear or dying) recurrent
suicidal ideation without a specific plan, or a suicidal attempt
or a specific plan for committing suicide.
B) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D) The symptoms are not due to the direct physiological effect of a
substance (eg: a drug of abuse, a medication) or a general
medical condition (eg: Hypothyroidism).
E) The symptoms are not better accounted for by bereavement; s.e,
after the loss of loved on, the symptoms persist longer than 2
months. Preoccupational with worthlessness, suicidal ideation,
psychotic symptoms or psychomotor retardation.
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EPIDEMIOLOGY:
Unipolar disorder: Females are more effected than males.
Upper social class is more effected.
20% American and European women have experienced major
depressive episode at some time.
15% of general population experience major depression
6-8% in primary care setting.
15% whose depressive symptoms untreated will committee suicide.
Life time prevalence 17-20%.
One year prevalence 5-8%.
The prevalence of depressive disorder in general medical practice
estimated 5-25%.
In rural primary health care clinic 20% severe cases, 43% mild cases.
M.S Bhatia 8
I. Lifetime Prevalence 2-25% (Females 5-9%, Males 2-4%)II. Male: Female ratio 1:2III. Age at onset Mid to late 20s.IV. Social Class No relationshipV. Race No differencesVI. Family History PositiveVII. In relatives
a. % Major depression 17%b. % Bipolar disorder 2-3%
VIII. Life events Negative events often before onset. (* based on Western studies )
Certainly not all major depressive episodes end in suicide, but
some do even in cases where the end is not this tragic. The pain and
suffering endured by the pre pressed person can be intense. The
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intensively painful nature of this disorder and its high incidence have
spurred mainly to study depression and its cause.
BROADER ASPECT OF DEPRESSION:(Severe Depression)
These cases represent only a small and visible “tip of ice burg”
of depression in ever society. There are literally hundreds thousand of
Americans an estimated 1 person in 7 who each day evidence “mild
depression”. Such depression usually occurs in response to very real
life stress, and while considered mild, it can be partially even totally
disabling. The complexity and rate of technological and social change
in our society, economic problems and uncertainties, and the
unhappiness and instabilities of money, marriages and other intimate
personal relationships are among the stresses which apparently take
their roll in episodes of depression as well as in other physical and
mental disorders. Often vicious cycle is established in which the
individual’s martial or other problems lead to the depression and are,
in turn, intensified by it. In fact, among teen-agers the suicide rates
the ultimate expression of the aversive ness of one’s life experience
has shown a significant increase in recent years.
MUNN’S 1 3 Contrary to popular opinion a major depression can
occur at any stage in life although it is more common between ages
40-55 in women 10years later in men.
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HARRISON’S 2 15% of general population experience major
depression. 6-8% in primary care setting. 10-15% secondary to
medicsal illness or substance abuse. 15% whose depressive symptoms
untreated will commit suicide.
Dysthymic disorders: Chronic at least 2years 5% in primary care
setting.
- Incidence more in women then men.
These gender differences were previously believed to reflect
socio cultured factors, but recent longitudinal twin studies. Indicate
that the liabili ty to major depression in adult women is largely genetic
in origin, and that the effect of environmental factors is transitory and
does not effect life time prevalence.
Unipolar depressive disorder
Onset early adulthood recurrence over the course of life time
are likely. 50-60 percent who have first episode have at least 1 or 2
more episodes. Some patients experience multiple episodes that
become more severe and frequent over time. The duration of on
untreated episode varies greatly ranging from a few months to 1 or
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more years. The pattern of recurrence and clinical progress in a
developing episode is variable.
There is a often long terms stability in phenotype (presenting
symptoms, Frequency and duration of episode)
In minority of patients the severity of the depressive episode
may progressive to psychotic symtometology.
A seasonal pattern of depression called. Seasonal effective
disorder may manifest with onset and remission of episode at
predictable time of the year.
This disorder is more common in women symptoms are fatigue,
weight gain, hypersomnia, episodic carbohydrate craving. The
prevalence increase with distance from equator, and mood
improvement can be accomplished with chronobiologic alteration of
light exposure.
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NIRAJ AHUJA 6 AETIOLOGY OR PREDISPOSITION:
Over the years a vast amount of data has emerged probing he aetiology of mood disorders. The aetiology of mood disorders is currently unknown. However, several theories have been propounded; these include:
I. Biological Theories
The following findings and theories point towards a biological basis of mood disorders.
1. Genetic Hypothesis
The life-time risk for the first degree relatives of bipolar mood
disorder patients is 25%, and of current depressive disorder patients is
20%. The life-time risk for the children of one parent with mood
disorder is 27% and of both parents with mood disorder is 74%. The
concordance rate in unipolar depression for monozygotic twins is 46%
and for dizygotic twins is 20%.
There fore, genetic factors are very important in making an
individual vulnerable to mood disorders, particularly so in bipolar
mood disorders. However, environmental factors are also probably
important.
2. Biochemical Theories
There are several biochemical hypothesis for the causation of
mood disorders. The monoamine hypothesis suggests abnormality in
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monoamine [caecholamine (norepinephrine and dopamine) and
serotonin] system in the central nervous system at one or more sites.
Acetylcholine and GABA are also presumably involved.
The earlier models of a functional increase (in mania) or
decrease (in depression) of amines at the synaptic cleft now appear
simplistic, though urinary and CSF levels of amine metabolites
indicate decreased norepinephrine and/or 5-HT function in depression.
Postsynaptic events involving he second messenger system, and
alterations in receptor number and function, are also important in
addition to synaptic and presynaptic events. The effects of
antidepressants and mood stabilizers in mood disorders also provide
additional evidence to the biochemical hypothesis of mood disorders.
Patients suffering from severe depression with suicidal
intent/attempt have a marked decrease in the serotonergic function,
evidenced by decreased urinary and plasma 5-HIAA levels and post-
mortem studies.
3. Neuroendocrine Theories
Endocrine function is often disturbed in depression with
cortisol hypersecretion, non-suppression with dexamethasone
challenge (DST or dexamethasone suppression test), blunted TSH
response to TRH, and blunted GH (growth hormone) production
during sleep.
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The neuro enmdocrine and biochemical mechanisms are closely
inter-related.
4. Sleep Studies
Sleep abnormalities are common in mood disorders. Insomnia
and frequent awakenings in depression. In depression, commonly
observed abnormalities are decreased REM latency (i.e. the time
between falling asleep and the first REM period is decreased),
increased duration of the first REM period, and delayed sleep onset.
5. Brain Imaging
In mood disorders, brain imaging studies (CT scan/MRI scan of
brain, PET scan, and SPECT) have yielded inconsistent, yet
suggestive findings (e.g. ventricular dilatation, changes in blood flow
and metabolism in several parts of brain, like prefrontal cortex,
anterior cingulated cortex, and caudate).
II. Psychosocial Theories
1. Psychoanalytic Theories
In depression, loss of a libidinal object, introjection of the lost
object, fixation in the oral sadistic phase of development, and intense
craving for narcissism or self-love have been postulated as theories.
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2. Stress
Increased stressful life events before the onset or relapse
probably have a formative rather than a precipitating effect.
Increased stressors in the early development are probably more
important in depression.
3. Cognitive and Behavioral Theories
The mechanisms of causation of depression according to these
approaches is depressive negative cognition (cognitive theory),
learned helplessness (animal model), and anger directed inwards.
These concepts are useful in the treatment of mild depression.
Several other theories have also been propounded but are
currently of doubtful value as theories of causation of depression.
Harrison 2 Aetiology a pathophysiology.
The neurobiology of unipolar depression is poorly understood.
Genetic transmission is not as strong as in bipolar.
Positron emission tomography (PET) studies of brain glucose
metabolism that show a decrease in metabolic rate in the caudate
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nuclei and frontal lobes in depressed patients that returns to normal
with recovery.
SPECT single photon emission computed tomography. Studies
show comparable changes in blood flow. MRT Show increase
frequency of subcortical white matter lesion. However, because there
finding are more prevalent in patients with late onset of depression
illness their significance remains unproven.
Involvement of the serotonin system is suggested by finding of
1) Lower plasma tryptophan levels.
2) Decreased CSF levels (5-Hydroxymdol acetic acid (The
Principal metabolite of Serotorine in brain)
3) Decreased platelet serotonergic transported binding.
4) Increase in brain 5-Ht receptors in suicide victors is also
reported.
Neuroendocrine abnormalities
1) Increase cortisol secretion.
2) Increase adrenal size.
3) Decrease inhibitory response of glucocorticoids to
dexamethosone.
4) Blunted response of T.S.H. level to infusion of T.R.H.
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5) Decreased in GHRH, GNRH (Gonadotrophic Realizing
Hormone)
Either genetically mediated or secondary to exposure to
significant stress during critical neuroendocrine encoding periods in
early development.
Dr. L.P. Shah and Mrs. Hemashah 3 Heredity suicidal
tendency, cyclothymic temperament high in family suffer from this
illness. Exact made of transmission is not known. In case of
endogenous depression autosomal dominant gene [non-sex-
determinating chromosome. In human there are 22 pairs] Which
carries illness parent to children.
Personality
Melancholic, anxious, obsessional personalities are more
predisposed to this illness.
Season
Incidence of depression reported more high in summer.
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Age
Onset usually after 25 to 30 peak 40-60also some children.
Sex
Both sex.
Precipitation
History of stressful environmental factors more often reactive
type than endogenous type.
Susceptible or predisposed
Persons exposed to stress in any form physical, physiological or
psychosocial precipitates the illness.
Endocrinal
Metabolic, biochemical, electrolyte disturbances are postulated
but not conductivity proved.
Disturbance in seratonergic and adrenergic Neurotransmiters
system
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Psychopathology
Not clearly understood may be result of anxiety who
experienced severe loss – angry – cannot tolerate – buried in
unconscious mind – guilty – worthless – depressed. Under stress
these feelings are reactivated and manifest as various symptoms of
depression.
MS Bhatia 8 Biochemical theories
a) Neurotransmitters
i) Deficiency of Norepinephrine and Serotonin has been found in
depressed patients.
b) Genetic theories
i) Twins Monozygotic versus Dizygotic: 68%:20%.
c) Psychological theories
i) Early childhood Experiences
- Maternal deprivation.
- Prolonged absence of a present.
ii) Sociological
- Life events e.g. death, marriage financial loss etc.
- Environmental stress.
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- Chronic conditions.
iii) Behavioural: Depression is conditioned by the repeated losses
in the past.
iv) Psychoanalytic theories
- Depression results due to loss of a love object.
v) Premorbid Personality
- Cyclothymic personality.
Dr.Mahesh A. Gandhi, Dr.Shradha M. Gandhi 1 4
Genetic factor
Hereditary factors play an important role. In unipolar mode of
transmission is not done, but it may be polygenic.
Institutional and Personality factors:
Body type is often pyknic. They may show a cyclothymic or
obsessive personality disorder.
Biochemical, Metabolic and endocrinal disturbances:
Indoleamines and catecholamines are major neurotransmissions
in those areas of brain that are concerned emotional functions. It is
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prepared that depression is accompanied by a decrease,
catecholamines. It appears at present, that depression may be an and
result of disturbances in different biochemical systems. Depressed
patients are also known to be hypersecretors of cortisol and normal
natural reduction in plasma cortisol does not occur in them.
Dexamethasone, a synthetic steroid, usually suppressor plasma
cortisol, but in about 50% of patient with major depression, it does
not occur, After recovery from illness the response becomes normal.
Psychoanalytic theory:
There is an imagined or real loss of an ambivalently loved
object. The anger which is to be directed towards the lost object is
directed towards the self, and this results in a lowered self esteem and
depression.
Cognitive theory of Beck:
Beck postulates that in some, distorted perception is the cause
of depression. He suggests that a person’s negative interpretation of
his won life experiences results in lowered self worth and depression.
API 1
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Genetic factor : Mood disorder are known to be heritable and familial.
Genetic factors more likely operative in bipolar least likely in
depressive disorder. Following Environmental stresses the reactive
depression. The exact mode of genetic transmission is not known. It
is postulated that genetic factors increase the predisposition to
develop a mood disorders but other factors like
a) Stressful bio-psycho-social environmental influence. May be
necessary for the disorder to manifest.
Biogenetic amine hypothesis:
According, depressive disorder result from absolute of relative
deficiency of these amines in the central synopsis (Biogenetic amine
namely catecholamines like epinephrine, nonepinephrine and
dopamine, and indoleamine serotonin.
Psychological factors:
Based on psychoanalytical principles first propounded by
Igmunt Frued. Accordingly depression usually occur in response real
or imagined disappointments, losses or disillusionments, failure to
adopt results anger directed inward resulting feeling of guilt and
worthlessness.
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Cognitive theory:
Faulty thinking pattern based on and life experiences.
a) Perceiving onsets as inadequate
b) Perceiving world as demanding
c) Expecting failure or defeat and results feeding of sadness
and despondences.
COLEMAN 7 NOTE ON SUICIDE
Attitude towards suicide varied greatly from one society to
another.
E.g.
1) The early Greek considered suicide an appropriate solution to
many stressful situation.
2) The Romans also considered suicide an acceptable solution to such
conditions, but it was forbidden when property rights or interests
of the states alter involved as when a slave or soldiers deprived the
state of his services by killing himself.
3) Suicide was condemned by both Judaism and Mohammedanism.
4) With the a event of Christianity, suicide was denounced as
grievous sin in most of western world.
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5) In early English law suicide was considered a crime and it was
directed that the bodies of a person who had committed suicide
have a stake driven through the heart and be buried at a crossroads.
These attitudes towards suicide as morally and legally wrong
prevailed throughout the middle age in western society.
During the Renaissance, however some philosophers dared to
challenge to prevailing vieurs. Merian 1763 concluded that suicide
was neither a sin nor a crime but a disease. Evidence of emotional
disturbances. French physician Jean Pierre Falret 1794-1870 to deal
extensively with the subject of suicide among outstanding historical
personalities. Falret 1822 performed “The first psychological
autopsy”. When he examined he possibility than Jean Jacques
Rousseay had taken his own life.
Suicide ranks among the first ten cases of death in most western
countries (W.H.O. 1974). In the United States, estimates show that
over 2,00,000 persons attempt suicide. 5 million living Americans
have made suicide attempts. Official figures show that some 25,000
successful suicides occur each gear, meaning every 20 minutes some
one in united states commit suicide.
WHO commits suicide
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- In united state, peak age for suicide attempts is between
24-44.
- More women make suicide attempts.
- Most suicide occur in severe life stress.
- For Females, most commonly used method is drug
ingestion; usually barbiturates.
- Suicide now ranks as the second most common cause of
death in the 15-24 age GP.
- Among Indian GP it is above 5 time and Average
(Frederick 1973)
- Other high gp includes depressed persons.
- 1) Whites, alcoholics, divorces, migrants, peoples from
socially disorganized areas.
- Both Female physicians and Female pscychologist commit
suicide at a rate about three times that of women in general
population.
Stress factors in suicide
Are not particularly different from those found in the affective
disorders.
1) International crises.
1) Marital conflict 3) Separation
2) Diverse 4) Loss of loved aims.
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2) Failure of self-devaluation
3) Inner conflict Net to struggle any longer
4) Loss of meaning a hope.
Suicidal Intent
Depression and suicide: It would appear that the majority – about ¾ of
all persons who do commit suicide are depressed at the time of
suicidal act. (Leonard 1974; Zung and Green 1974). Individuals
ability to think rationally is of ten impaired.
As Farberow and Litman (1970) have expressed it. Depressed
person is emotionally incapable of perceiving realistic alternative
solution to a difficult problem. His thinking process is often limited
where he can see not other way out of a bad situation other than that
of a suicide.
Farberow and Litman (1970)- echoing Hanlet – have classified
suicidal behavior into 1) “To be”, 2) “Not to be” 3) “To be or not to
be”.
1) “To be” – who donot really wish to die.
2) “Not to be”- Seemingly are interest on dying.
3) “To be or not to be” – 30% suicidal population.
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GENERAL SOCIO-CULTURAL FACTORS
1. Hungary – 33% per 1,00,000
2. Western 20 per 1,00,000
3. Czechosolovakia, Finland, Austia and Sweden.
4. United State 12 per 1,00,00 (Canada)
5. Mexico, New Guinea, Phillipine 1 per 1,00,000
6. Islands less than 1 per 1,00,000
7. Primitive GP such as aborigines or Australian Western
deserts 0%
8. Catholicism and Mohammedanism strongly condemn
suicide
9. Catholic and Arab countries Low
10. Japan – Socially approved under certain circumstances
11. Low income persons from large urban areas.
SUICIDE PREVENTION (Page 615)
An extremely difficult problem. Most persons who are
depressed and contemplating suicide do not realize that their thinking
is highly restricted and irrational and that they are in need or
assistance. Less than 1/3 voluntarily seek help, if the individual “Cry
for Help” can be hard in time, it is often possible to successfully
inference.
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Crisis Intervention: Primary objective or such crisis therapy to help
the individual regain his abilit ies to cope with his immediate problem
and to do so as quickly as possible.
Emphasis is usually placed on
1) Maintaining contact with the person over a short period or time –
usually 1-6 contacts.
2) Helping the person realize the acute distress is impairing the
ability to asses his life situation accurately and to choose among
possible alternatives.
3) Helping the person see that there are other ways or dealing with
his problem that are preferable to suicide.
4) Taking a highly directive as well as supportive role.
5) Helping the person see that his distress and emotional turmoil will
not be endless. These are “Stopgap” measures rather than complete
therapy. Ad Seiden has expressed it, the suicidal crises “is not a
lifetime characteristic or most suicide attempters. It is rather an
acute situation often a matter of only minutes or hours at the most.
Suicide attempters remains relatively high gp risk, who appears to
need more assistance. For individual in the first gp crisis
intervention is usually sufficient to help them cope with the
immediate stress. Situation and regain their equilibrium. For
individuals in second to help them deal with the present problem
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situation, but their lifestyle or “staggering” from one crisis to
another makes then a very high risk gp who need more
comprehensive therapy.
NIRAJ AHUJA 6 CLINICAL FEATURES AND DIAGNOSIS:
DEPRESSIVE EPISODE:
The life-time risk of depression in males is 8-12% and in
females is 20-26%, though the life-time risk of major depression or
depressive episode is about 8%. The typical depressive episode is
characterized by following features (which should last for at least two
weeks).
SOMATIC SYNDROME IN DEPRESSION (ICD-10)
The somatic syndrome is characterized by:
Significant decrease in appetite or weight
Early morning awakening, at least 2 (or more)
hours before the usual time of awaking.
Diurnal variation, with depression being worst in
the morning.
Pervasive loss of interest and loss of reactivity to
pleasurable stimuli.
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Psychomotor agitation or retardation.
1. Depressed Mood:
The most important feature is the sadness of mood or loss of
interest and/or pleasure in almost all activit ies (pervasive sadness),
present throughout the day (persistent sadness). This sadness of mood
is quantitatively as well as qualitatively different from sadness
encountered in normal depression or grief. The depressed mood varies
little from day to day and is often not responsive to environmental
stimuli.
The loss of interest in daily activit ies results in social with drawal,
decreased ability to function in occupational and interpersonal areas
and decreased involvement in previously pleasurable activities. In
severe depression, there may be complete anhedonia (inabili ty to
experience pleasure).
2. Depressive Ideation / Cognitions
Sadness of mood usually is associated with pessimism. This results
in 3 common types of depressive ideas, i.e.
a. Hopeless (‘there is no hope in future
due to pessimism’).
b. Helplessness (‘no help is possible’).
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c. Worthlessness (‘feeling of inadequacy
and inferiority’).
The ideas of worthlessness can lead to self-reproach and guilt-
feelings. Other features are difficulty in thinking, difficulty in
concentration, indecisiveness, slowed thinking, subjective poor
memory, lack of initiative and energy. Often there are ruminations
(repetit ive, intrusive thoughts) of pessimistic ideas. Thoughts of death
and preoccupation with death are not uncommon.
Suicidal ideas may be present. In severe cases, Delusions of
nihilism (e.g. ‘world is coming to an end’, ‘there is no brain in the
skull’, ‘intestines have rotted away’) may occur.
SUICIDAL RISK: IMPORTANT FACTORS
Suicidal risk is much more in the presence of following factors:
Presence of marked hopelessness.
Males; age >40; unmarried, divorced or widowed.
Written or verbal communication of suicidal
intent and/or plan
Early stages of depression
Recovering from depression (At peak of
depression, patient is usually either too depressed or too retarded
to commit suicide).
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Period of 3 months from recovery.
3. Psychomotor Activity
In younger patients (<40 year old), retardation is more common
which is characterized by slowed thinking and activity, decreased
energy and monotonous voice. In severe form, patient becomes
stuporous (depressive stupor).
In older patients (e.g post-menopausal women), agitation is
commoner with marked anxiety, restlessness (inability to sit still ,
hand-wriggling, picking at body parts or other objects) and subjective
feeling of unease.
Anxiety is a frequent accompaniment of depression. Irritabil ity
may present as easy annoyance and frustration in day-to-day
activities, e.g. unusual anger at the noise made by children in the
house.
4. Physical Symptoms
Multiple physical symptoms (like heaviness of head, vague
body aches) are common in elderly depressives and patients from
developing countries (e.g. India). Hypochondriacal features may be
present in up to a quarter of depressive presenting for treatment.
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These physical symptoms are almost always present in severe
depressive episode.
Another common symptom is complaints of reduced energy and
easy fatigability. Patients, therefore, not surprisingly attribute their
symptoms to physical cause(s).
5. Biological Functions
Disturbance of biological functions is common with insomnia
(sometimes hypersomnia), loss of appetite and weight (sometimes
hyperphagia and weight gain) and loss of sexual drive.
When the disturbance is severe, it is called as melancholia
(somatic syndrome in ICD-10, Diagnostic Criteria for Research). The
somatic syndrome of depression is described in Table 6.1.
The presence of somatic syndrome in depressive disorder signifies
more severe and more biological nature of the disturbance. It often
also implies a good response to somatic methods of treatment (e.g.
pharmacotherapy, ECT).
6. Psychotic Features
15-20% of depressed patients have delusions, hallucinations,
grossly inappropriate behavior or stupor. Psychotic features can be
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mood-congruent (e.g nihilistic delusions, delusions of guilt, delusion
of poverty, stupor) which are understandable in the light of depressed
mood, or can be mood-incongruent (e.g. delusions of control) which
are not directly related to depressive mood.
7. Suicide
Suicidal ideas in depression, if expressed, should be taken
seriously. Although there is a risk of suicide in every depressed
patient with suicidal ideation, presence of certain factors increases the
risk of suicide.
8. Absence of an Underlying Organic Cause
If depressive episode is secondary to an organic cause, a diagnosis
of organic mood disorder should be made.
In ICD-10, the severity of depressive episode is defined as mild,
moderate or severe, depending primarily on the number of the
symptoms, but also on the severity of symptoms and the degree of
impairment.
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RECURRENT DEPRESSIVE DISORDER
This disorder is characterized b recurrent (at least two)
depressive episodes (unipolar depression). The current episode in
recurrent depressive disorder is specified as: mild, moderate, severe
without psychotic symptoms, severe with psychotic symptoms, or in
remission.
PERSISTENT MOOD DISORDER
These disorder are characterized by persistent mood symptoms
which last for more than 2 years (1 year in children and adolescents)
but are not severe enough to be labelled as even hypomanic or mild
depressive episode. If the symptoms consist of persistent mild
depression, the disorder is called as dysthymia; and if symptoms
consist of persistent instability of mood between mild depression and
mild elation, the disorder is called as cyclothymia.
API 1 Depressive Symtamatology
1) Pervasive and sustained mood of sadness.
2) Retardation activity, restless agitation, may lead to stupor.
3) Pessimism sense of hopelessness, helplessness, guilt self
deprecation, and ideas or delusion of poverty, sin or crime.
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4) Distortion of time sense (a moment seem an aternity)
5) Sensory perceptions, lack of brightness in things they see when
handling things lack of sense of contact, people and places look
different to them.
Physicals:
1) Loss of Appetite
2) Loss of weight
3) Loss of energy
4) Fatigability and multiple somatic complaints
5) Reduced sleep in quantity and quality, waking 2-3 a.m. failure
sleep) nightmares, disturb dreams, fails to bring morning
freshness. Sometime hypersomnia.
6) Suicidal ideations, feeling of guilt, sin, data indicate 18%
suicidal behavior in major depression.
7) Delusion of illness like cancer.
8) Looking for older than age.
9) Interest, poor concentration, memory failure in social,
occupational and sexual spheres.
10) Diurnal variation early morning worsening, improvement in late
evening and early night. (Depressed patient whom morning sun
foils to bring cheer, dislike breakfast, correspond to “owl type”
said by William Osler.
11) Aches and pains associated with other depressive symptom.
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12) Pain in head, face, eyes, neck, chest, abdomen, pelvis, limbs, back,
facial and trigeminal neuralgias.
13) Acute localize pain may occur in emergencies, angina pains.
Dr. L.P. Shah, Mrs. Hema Shah 3 Clinical Manifestation: Changes
in Soma and psyche all systems are affected greater or lesser degree
as
a) Physical b) Emotional c) Psychological.
a. Physical: Tired, listless, rundown,
fatigue, insomnia, anorexia, low weight, bulimia, increase in body
weight, abdominal discomfort, hot flushes, vague aches and pains,
tingling, numbness, dryness of mouth, constipation, urinary
frequency, menstrual changes like amenorrhoea, menorrhagia,
reduced sex, lack of interest and impotency, cardiovascular
disturbances, pain in chest, palpitation, breathlessness, headache,
heaviness of head, giddiness, blurred vision, dermatological
disturbance, pruritis, rash, increased and decreased perspiration,
neurodermatitis.
b. Emotional: Despondency, gloomy, loss
of cheerfulness, reduced enthusiasm, lack of interest, crying spells,
lack of confidence, irritabil ity, unexplained fears (phobias),
hunting ideas (obsessions), anxiety, feeling of guilt, worthlessness,
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uselessness, hopelessness, suicidal tendency, ruminations and
attempts.
c. Psychological: When specially
enquired usually remains un-reported. Psychomotor retardation,
slowing down physical and mental function, agitation, avoiding
people, social responsibilities, tendency to postpone, neglect of
daily routine, negativism, stupor, impaired concentration and
forgetfulness, delusion of various types illusions, hallucination,
unexplained worries and anxieties.
Bimla Kapoor 1 5 Depressive Episodes: In depression the classical
Triad symptoms are:
i) Depressed mood
ii) Slowed or Related thinking and
iii) Psychomotor Retardation.
Depressed type of MDP is described (i) Mild Depression, (ii) A
Depression and (iii) Depressive Stupor.
i) Mild Depression: The patient is rigid ethically and has moral
standards. He is multiculor and perfectionist, self-depreciatory,
sensitive to criticism. In mild depress the patient feels fatigued and
staleness. Physical complaints with organic cause. Blue spells, the
patient lacks confidence in himself. Low his zest and interest for
living. Feels inadequate, shows growing averse to activity. Likes
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to be left alone and finds difficulty in perform his ordinary duties.
Appetite and sleep are decreased. The patient looks stale.
ii) Acute or Severe Depression: In these cases the patient’s body is
stooped, head flexed, face immobile forehead furrows, looks
fixedly downward. Tongue is coated, markedly loss of appetite.
Loss of weight, disturbed sleep. Hypochondrical ideas. Feelings-
the patient says that he has no feeling, no interest in any activity.
Retarded thoughts: the patient’s replies are brief and
monosyllabus. Expresses in a very low tone, answers with great
effort and appear to use a lot of energy to answer questions. Has
suicidal ideas. Psychomotor activity is markedly decrease. Is
preoccupied in his own thought. Gradually these patients progress
towards stupor, if not treated. Gradually these patients progress
towards stupor, if not treated.
iii) Depressive Stupor: It is the most intensive form of
depression. The patient present with acute dementia, mute,
sensorium is clouded, and he is intensive preoccupied. He has
dream-like hallucination and marked ideas death.
NOTE ON TYPES Dr. L.P. Shah, Mrs. Hema Shah 3:
Typical: Appear in pure form
Atypical: Associated with other conditions.
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Typical:
a. Autogenous:
iv) Endogenous depression (due to autosomal dominant gene
carriers, illness from parents to children).
v) Involutional depression
vi) Psychotic depression
b. Reactive depression (depressive neurosis)
i) Bipolar or unipolar.
ii) Primary or secondary
SL. No
Autogenous Reactive
1. Significant stress situation preceding attack minor.
Severe intensity
2. Biological factors importance (heredity, constitution)
Environmental factors
3. Cyclothymic persons (swings of mood)
Anxious persons
4. Melancholic personality (severe for me of major depression)
Obsessive personality
5. Insomia early morning 2-3 a.m. Early night
6. Miserable morning than evening More worst evening than morning
7. Feel same when alone or group Feels better in group
8. Suicidal tendency more Less
9. Relapses common Uncommon
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10. ECT and anti depressants Psychotherapy and case work
Brief Description of various type:
Depressive phase or manic depressive psychosis:
Is functional psychosis alternation with manic and depressive
psychosis. Persons usually have cyclothymic temperament history
of family member suffered, transmitted through autosomal genes
(endogenous).
Involution: Melancholia 45-55 years female-
menopausal. Asthenic (weak) body weakness, anxiety,
hypocondrias, obsessive.
Psychotic Depression: To external stress
traumatic experience, no history of repeated depressive episodes or
cychlothymic mood swing pyknic body (short), hereditary not
reported causes viral infection, mal nutrition, psychosocial
environmental stress.
Reactive Depression: In anxious, melancholic,
obsessive personality. Illness preceded by physical, physiological
and psychosocial stress like sudden death, loss of job, loss of
prestige, financial stress, marital and sexual disharmony.
M.S. Bhatia 8 Differential diagnosis of major depressive episode
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a. Organic Mood (Affective) Syndrome
with depression.
b. Primary Degenerative or Multi infarct
Dementia.
c. Schizophrenia
d. Schizoaffective
e. Dysthymic and Cycothymic disorders
f. Chronic Mental Disorders.
g. Anxiety Disorders
h. Uncomplicated bereavement
i. Others, e.g. Primary hypochondriasis,
traumatic neurosis or Adjustment Disorder with Depressive
features.
NIRAJ AHUJA 6 COURSE AND PROGNOSIS
Unipolar depression is common in two age groups: late third
decade and fifth to sixth decades. Depressive episode lasts from 4-6
months. Unipolar depression lasts usually longer.
With rapid institution of treatment, the major symptoms of
mania are controlled within 2 weeks and of depression within 6-8
weeks.
Nearly 40% of depressives with episodic course improve in 3
months, 60% in 6 months and 80% improve with in a period of one 51
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year. 15-20% of patients develop a chronic course of illness, which
may last for two or more years. Chronic depression is usually
characterized by less intense depression, hypochondriacal symptoms,
presence of co-morbid disorders (like dysthymic disorder, alcohol
dependence, personality disorders and medical disorder), presence of
ongoing stressors and unfavorable early environment.
As the age advances, the normal intervals between two episodes
shorten and, the duration of the episodes and their frequency increase.
Although not all patients have relapses, it has been estimated that up
to 75% of patients have a second episode within 5 years.
Some patients of bipolar mood disorder have more than 4
episodes per year; they are called rapid cyclers. 70-80% of rapid
cyclers are women. When the phases of mania and depression
alternative very rapidly (in matter of hours or days), the condition is
called as ultra-rapid cycling.
Some of the factors associated with rapid cycling include the
use of tricyclic anti-depressants, low thyroxin levels, being a female
patient, bipolar II pattern of illness, and the presence of neurological
disease.
There is an increased mortali ty in patients with mood disorders
by almost two times the general population. The most important cause
of death is suicide, the life-time risk of which is 10-15 times higher in
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depression. Patients with depression also exhibit a variety of
disturbance in immune function.
PROGNOSIS
Classically, the prognosis in mood disorders is described as
better than in schizophrenia. The good and poor prognostic factors in
mood disorders are described below:
PROGNOSTIC FACTORS IN MOOD DISORDERS
Good Prognostic Factors:
Acute or abrupt onset
Typical clinical features
Severe depression
Well adjusted premorbid personality
Good response to treatment
Poor Prognostic Factors:
Co-morbid medical disorder(s), personality
disorder(s) or alcohol dependence.
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Double depression (acute depressive episode
superimposed on chronic depression or dysthymia)
Catastrophic stress or chronic ongoing stress
Unfavorable early environment
Marked hypochondriacal features, or mood
incongruent psychotic features.
Poor drug compliance.
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Review of Literature
A NOTE ON GRIEF AND DEPRESSION
Features Grief Depression*
1. Identification with deceased Normal Abnormal
2. Ambivalence Less More
3. Suicidal ideas Rare Common
4. Global worthlessness Rare Common
5. Self-blame Limited to loss
Global
6. Response evoked from others Empathy; Sympathy
Annoyance; Irritation
7. Self-limited Usually May not be
8. Response to assurance Good Poor
9. Vulnerabili ty to physical illness Increased Increased
* Depression means here severe depression
A. Altschul A.R., Simpson 1 6 General Management and Nursing
Care:
Nursing patients who feel depressed: Can keep Psychiatric nurses who
know something about the disorders they are helping to prevent and
cure, and about mental health which they are trying to restore. The
nurse should be able to give warmth, even though she does not receive
any response.
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Review of Literature
1) Physical Care
2) Suicidal tendencies, observations (routine, precaution against
suicide)
3) Dangerous objects away (Eg. Poison, sharp instruments)
Elizabeth B. Hurlock 1 7: Early Adulthood personal and social
adjustment:
Early adulthood extends from age 18 to appointment age forty.
Early adulthood is a period of adjustment to new patterns of life
and new social expectations. Early adulthood is
a) Settling down age
b) Period of emotional tension
c) Period of social isolation
d) Period of time of commitment
e) Period of dependency
f) Period of time of value change
g) Period of as the time of adjustment to new lifestyle
h) Period of creative age
When emotional tension persists their worried may be mainly
concentrated on their work because they feel they are not advances as
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Review of Literature
rapidly as they or worries may be concentrated on marital parenthood
problems. When they feels that they are not able to cope up with the
problems, often emotionally disturbed that they contemplate or
depressed attempts suicide.
Conditions responsible for interest change adulthood
1) Changes health condition
2) Changes in economic status
3) Changes in life patterns
4) Change in value
5) Sex role changes
6) Changes from single to married status
7) Assumption of Parental Role
8) Changes in Preference
9) Changes in cultural & environmental pressure
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Homoeopathic Review
PSYCHOTHERAPY Bimla Kapoor 1 5 In treatment modalities for psychiatric patients
the approaches used are: Psychopharmacology (Unit XV),
Psychotherapies or Psychological treatments and somatic therapy or
physical treatment. In this unit the emphasis will be on psychological
treatment or psychotherapies. Psychotherapy is the treatment used for
a patient with emotional and personality problems. It is also used for
problems which originate due to psychological factors. The basic
principle I psychotherapy is the Therapist-Patient Relationship. (Refer
Chapter V, Unit XIII).
Psychotherapy involves talking with a trained mental health
professional, such as a psychiatrist, psychologist, social worker, or
counselor to learn how to deal with problems like anxiety disorders.
Definition Of Psychosocial TherapyPsychotherapy is the treatment of personality problems,
maladjustments and mental disorders by psychological means.
Wolberg (in Longman Dictionary of Psychology and Psychiatry)
defines psychotherapy as, “A form of treatment for problems of an
emotional nature in which a trained person deliberately establishes a
professional relationship with the objective of removing, modifying or
retarding existing symptoms, of mediating disturbed patterns of
behaviour, and of promoting positive personality growth and
development”.
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Lego S. defines psychotherapy as, “A method of treatment
based on the development of intimate (therapeutic) relationship
between client/ patient and therapist for the purpose of exploring and
modifying the client/patient’s behaviour in a satisfying direction”.
A Psychiatric Glossary (1980) defines psychotherapy as, “A
process in which a person who wishes to relieve symptoms or resolve
problems in living or is seeking personal growth enters in implicit
contract to interact in a prescribed way with a psychotherapist”.
All the three definitions emphasize the basic concepts that: 1)
In psychotherapy a therapeutic relationship is established between the
patient and the therapist; 2) The purpose of psychotherapy is to
modify, remove or reduce the factors causing a disturbed behaviour
and, 3) To help the patient to grow and develop coping mechanism to
face the problems in future, and improve in social functioning.
Goals Of Psychosocial TherapyThe goals of psychotherapy are to help the patient in:
i) Changing maladaptive behaviour patterns.
ii) Reducing or eliminating environmental
conditions that may be causing such a behaviour.
iii) Improving interpersonal and other
competencies, i .e. communication skills.
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iv) Helping the patient to resolve inner conflicts
and overcome feelings of handicap (such as the patient feels he
can’t socialize, or take a decision or communicate effectively).
v) Modifying an individual’s accurate
assessment of himself and the world around him.
vi) Helping him to develop a sense of self-
identity.
So, psychotherapy helps in reducing the patient’s discomfort,
improving his social functioning and ability to perform act
appropriately.
Supportive Psychotherapy It is a form of “surface therapy”. The therapist helps the patient
client to relieve emotional distress and symptoms without problem
into the past or attempting to change or alter the basic personality of
the client and utilizes various techniques such as:
i) Ventilation
ii) Environmental manipulation;
iii) Persuasion;
iv) Reeducation and v) Reassurance.
Behavioural PsychotherapyIt is a form of psychotherapy which focuses on modifying faulty
behaviour rather than basic changes in the personality. Instead of
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probing the unconscious or exploring the patient’s thoughts and
feelings, behaviour therapist tries to eliminate the symptoms and
modify ineffective or maladaptive patterns by applying basic learning
techniques. The approaches are based on the clinical application of
classical and operant conditioning principles originated by Pavlov and
Skinner respectively.
Interpersonal Psychotherapy (IPT)
Developed by Klerman et al (1984). It focuses on current
interpersonal problems in out patient nonbipolar, nonpsychotic
depressed patients.
Interpersonal therapy is the term used by J.L. Morena for a type
of psychotherapy in which there is emphasis on the interpersonal
relationship of the various persons involved, such as husband, wife
and one or more other parties.
Coleman J.C. included marital and family therapy and
transactional analysis in interpersonal psychotherapy.
TypesMarital Therapy:
This psychotherapy is directed at improving a disturbed marital
relationship. It is centred on efforts to change the psychodynamics
and behaviour of the partners. The sessions are usually conjoint. In a
conjoint session two partners meet the therapist in joint sessions.
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Marital therapy may be conducted on a problem solving level in which
grievances are aimed and clashes worked through or on a more
analytic level focusing on dreams, unspoken communication and the
sources of defensive or aggressive attitude.
For example, the husband may say during the sessions. “She
does not have any compliant against me, but still she is not happy that
makes me uncomfortable”. During the session the wife may start
crying and confess, “Often I wanted to reply him back but seeing his
anger and children around me I have been withdrawing into silence.
But what’s the use of talking?”
In other words, insight is shared by the couple which may help
them in a satisfactory marital relationship.
Family TherapyIt is a form of group psychotherapy in which the family is a
therapeutic unit. Family is the matrix out of which all human
interactions develop. The objective of family therapy is not merely to
improve relationship but to modify home influences that process, the
therapist helps individual members to become aware of their distorted
reactions and defensive patterns used by them. The therapist also
encourages the members to communicate more meaningfully and
handle their difficulties in a constructive manner.
Most of the psychopathology in an individual occurs due to the
way he deals with his intimate relationship with family members.
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Changes in the individual behaviour can only occur if there is a
change in all the members of the family.
Clifford T, Morgan, King, Neisz, Schopler 4 2 Life experience, learning
and social interaction in depression
In psychoanalytic theory Depression is seen as resulting from
on overly demanding superego. One that sets standards to high for the
person to line up to and from early loss or attachment figures.
Cognitive Processes and DepressionDepression involves a kind of “giving up”, or cleaned
helplessness. Step trying to make the things better. If people attribute
this lack of control to personal causes their self esteem will be
impaired. If they believe the causes are stable, then their depression
will be long lasting. If they believe their lack of control extents to
many situation, then their depression will be generalized across
situations. In other words depression is colored by cognition.
Aaron Beck (1974, 1976) is another theorist who emphasizes
cognitive, or thought aspect of depression. He sees primarily
depression as a thorough disorder and on secondarily as a mood
disorder. According to Beck depressed persons are dominated by
negative views of self, the outside world and the future. They see
themselves as losers, and all their perceptions are coloured by this
major premise, Beck (1974) further prepared than depressed people
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experience major distortions of logical thoughts. These distortions
include:
1. Arbitrary Inference: Drawing a conclusion base on too little
evidence or no evidence at all (eg. A house wife concludes that her
husband does not love her he leaves for work every morning.
2. Selective Abstraction: Drawing a conclusion by concentrating on
an detailed aspect of situation.
3. Over Generalization: Unjustified generalization from limited
evidence (eg. A student who receives a low grade on a single
assessment is say that he or she failing the course and will never
graduate or get a job).
4. Magnification and Minimization: Exaggerating or limiting the
significance of information (A dropped stitching Sweater makes
the Kitter want to thro it away (magnification), an employee
continuous to feel in competent even after given a raise
(minimization).
In contrast to Beck’s view some recent research suggested the
depressed people may actually make more accurate assessment of
themselves and certain situation than non-depressed people. For
example in one study (Lewinsohn et al, 1980) depression may be,
inpart a breakdown of this process.
A careful review of the research on cognitive processes (Coyne
and Gotlib 1983). Some truth in each model, but there may be also
several ways of thinking that can go along with being depressed.
SHORT-TERM PSYCHODYNAMIC PSYCHOTHERAPIES:
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Group Therapy
Millieu Therapy
HOMOEOPATHIC REVIEW
P.N. Banerjee 1 8 Mental illness are recognized as disease only when
the man is considered insane and is, as such, unable to perform his
usual functions, and it is the monthly that some course of treatment is
sought. But if are look deeper into the matter and watch the condition
of minds of those around, perhaps we will hardly find one man with
sound mind out of one thousand individuals. And yet there is no
anxiety in any body for freeing the mind of its disease. It is really
unfortunate. E.g. The thief certainly knows that stealing is bad will
put him in “Jail”, when he is caught, and he is certainly, therefore,
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Homoeopathic Review
tries to avoid stealing, but yet he steals. The explanation is that he
cannot avoid it, and that means that his mind is ill , that his mind is
diseased. The sound, healthy mind, cannot have the first impulse of
stealing not to speak of making a habit of it. The sound mind cannot
have the inclination for felling an untruth. Compulsions and
tendencies comes from diseased mind. Bad thoughts and bad actions
are impossible in a healthy mind. Disease originates from mind (38)
evil thoughts – evil action – mind shapes the body. If you want to
keep the body in health, you must take care of the mind first (39)
when anything or any medicine acts an body, the first touch of that
action is on the mind(40). Of the thing acting is a material. If any
thing is to act on mind it has to be on the care plane, of the same
fineness and subtlety as the mind. Because material enter converts in
to a fineness to reach the mind (40). The mind of Psora Sycosis
Syphilis are very fine-as fine as subtle as the mind, - as this is why
they are able to act on it at once (40) higher potencies commenced
their immediate action on mind (40).
P.N. Banarjee 1 8 The elements of the mind are not considered to be if
much consequence, at least so long as they do not assume such
dimensions to affect notice and to render the man incapable of his
usual duties, (34). Bad thoughts and bad actions are impossible in a
healthy mind (36,37). Disease originates from mind. Evil thoughts
first and than evil action (38). It is the mind that shapes the bodies.
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Homeopathic medicine in low potencies fails to act on the mind, but
when they are of higher potencies, this first action is on the mind
(41). The primary infection of the mind mentioned above is connected
at once, the mischief if ends there.
R.E. Dudgeon 1 9 Eventually establishing a dramatic care of a patient,
Herr. Klockenbring. The account of this care, was published in 1796
and this proves Hahnemann was one of the earliest, if not the very
first, (1b1d) to advocate a “treatment” of the insane by mildness
rather than coercion. In fact, it was on 2 n d sep. 1793, that “Pinel
made his first experiment of unchaining manias in the Bicetre”.
Which was some 15 months after Hahnemann had-commenced treating
Klockenbring.
This single incident undoubted provided Hahnemann with
insane pioneering ideal about the nature of mental disease and how
sufferings ought to be treated.
Richard Haehl, M.D. 2 0 As to the individual characteristics of each.
Patient he had always been accustomed to pay the greatest attention,
not only to the particular. Physical constitution, but above all to the
mental and temperamental nature of the subject were are thus in a
position to understand the unusual interest and the fine understanding
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Homoeopathic Review
which is exhibited for the unfortunate victims of mental derangement
with these principles. Hahnemann was originating entirely new
methods in the treatment of mental patients, independently of his
famous contemporaries Pinel and Reil. As a matter of a fact
Hahnemann actually acquired for himself in psychiatry a great on
merit than Pinel. An impression that Hahnemann possessed on
extraordinary understanding for the nervous and mental activities of
his patients. Numerous passages in aphorism 210-230 prove
irrefutably that Hahnemann was very much interested in these
methods and indeed considered psychotherepy in certain cases to be
more important, more applicable than the use of Homeopathic
medicines.
The Anatomist and psychiatrist Reil (1759-1813) was a “Friend
of Goethe and publishers of various medical journals, who was the
first to use the term” psychiatry. The treatment of melancholy
included pleasing physical stimuli such as heat, studying esthetic
paintings, strolling, and swinging”.
The chief resource that is alluded to by others in support of
Hahnemann superior and prophetic views on mental illness is his
treatment Klockenbing in Georgen that in 1792. This even was
certainly critical in formatively creating own views on this subject.
Hahnemann entry into the psychiatric field was four years before
William Tuke, the English Quaker had finally established the retreat
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Homoeopathic Review
in Yort-and a year before. Pinel reformed the Bicetre Asylum in Paris,
(Hobhouse 85).
At the time of Hahnemanns incursion into his field, the insane
were “treated like wild animals…….. chained in dungeon-like cells”,
(Cook, 62). The usual treatment at the time was “by violence……..
whipping a dungeons”. (Bradford. 54).
Bradford 2 1 Hahnemann also appreciated the importance of the
law of similars when he referred to a care by Hippocrates of his
friends mania by the use of Hellebore (which can) produce the
symptoms of mania, (Hobhouse, 92) Apparently this observation
provided one confirmation for his idea of the central importance of
similar medicine.
During the two years following his translation Cullen’s Materia
Medica and the apochal Cinchona bark proving in 1790 that derived
from it, Hahnemann “continued to experiment upon himself and on his
family and certain of his friends with different substances”,
(Bradford, 52). But he had not yet, tested the truth of his new
principles the sick. The insanity of Klockenbring gave him the
opportunity. However, for the first few weeks Hahnemann simply
observed Klockenbring without giving him any medicine treatment.
(Hobhouse, 89).
During the first weeks simply watched him, without giving him
any medical treatment (Hael 1-42).
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Klockenbring had been Hanoverian minister of pollex and
secretary to the chancellery (and) in his fast life, he developed great
eccentricity (Bradford, 53), but he became the subject of a satire
claiming he was a close associate of drunken brothel keepers and that
he had the most dangerous venereal disease and moral vies ranging
from drunkenness to fraud. (Cook 62)
As a public figure and family man who could not stand such
accusations, he became violently insane, (Bradford, 53). “In June
1792 he was brought to Georgenthal”, (Hael 2-33).
Richard Haehl 2 2 Being so violent that he was escalated by two well-
built men to keep him under control (Cook, 63). His face was covered
with large spots, was dirty, and imbecile in expression. Day and night
he craved. He was afflicted with strange Hallucinations would recite
in Greek actual words of Hebrew text, Bible story to his keepers he
destroyed his clothing and bedding, took his piano to pieces and
exhibited most perfect form of excitable manias (Bradford, 54-55).
As cook suggests, it seems likely that his raving were indeed those of
the tertiary stages of syphilis, (Cook, 63), as his cruel satirist had
suggested in the first place.
Hahnemann found by experience that home treatment is not
suitable for all cases of insanity (Haehl 1-43).
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Dr. T.P. Chatterjee 2 3 In the present-day world, the stress strain
syndrome has generated a vicious circle of disease for which
everybody is paying dearly in the course of his struggle for existence.
Brings about disharmony in the vital dynamic which languishes in its
trail and struggle helplessly by giving more subjective symptoms –
mental and emotional – than corporeal. Hahnemann who gave first
scientific touch to the so called mental diseases in his organon, the
Bible of Homeopathy. Classification as per modern terminology, may
be called
1) Neurosis aph 224
2) Acute emotional diseases 221, 222
3) Psychosomatic disease 225, 226
4) Somato psychic disease 226, 229
Hahnemann recognized psora as the basic miasm has
recommended anti - psoric remedies for a cure. (Any un due
aberrations carried by sudden shock, strong emotion, maladjustment in
social-economic life including marital relations deep resentment,
suppressed desires and emotions, sensuous living, depressing
disappointments in life, make the simple aberration of mind more
permanent and it is here that psora gives a leading hand to the other 2
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Homoeopathic Review
miasm. Inter-action of these miasm makes life miserable, to chronic
diseases and prompts even suicide) (83).
Dr. Ortega 2 4 has point out
2) A slow sluggish or depressed mind – psoric
3) A hyperactive, hurried psychism will tend towards a changing
and unstable psychism which will make evident the hypertophy of
the ego in the sycotic individual.
4) The degenerative depravation that should the spirit with its
tendency towards destruction and death will constitute the
syphill itic position (83).
Physician he has to be psychiatrist in addition. And here Hahnemanns
“friendly exhortations”.
a) Consolatory arguments.
b) Sensible advice.
c) Serious representation.
d) Well disguished deception aph 226 comes into play.
He has advocated importance of
2) Gently
3) Sympathetic and human behaviour towards the mental
patients.
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Sarkar B.K. 2 5 Mental diseases and their treatment in apho 210-230
mental disease classification by Hahnemann.
1) Corpo - mental.
2) Mento corpal.
3) Sudden outburst of insanity and mania
4) Doubtful in origin.
PLACE OF DEPRESSION IN WOMEN DUE TO FAMILY
STRESSOR IN HAHNEMANNS CLASSIFICATION
Hahemann considers mental disease as one sided diseases of the
chronic type affecting the whole psychosomatic entity where the front
of derangement has been shifted on the mental aspect of the human
organism after the physical disturbances have been suppressed by
unhomoeopathic treatment or through some other natural cause (215-
216).
Hahnemann states in mento-corporeal type. Where the mental
aspect is primarily deranged and those disturbances finding the body
slightly yielding to the altered psychological conditions maintain the
body in a disturbed condition and continue the psycho-pathological
state of the patient. These are also continued in a vicious circle by
emotional case, such as ancient worry vexation wrongs and the
frequent occurrence of great fear fright (414).
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Illness has been defined by F. Mobras a living even taking place
in a living organism which is itself alive only by virtue of the fact
that in it, psychic and somatic are united in a living unity. Certain
stressors are there by set up that discharge. Themselves among the
various peripheral nerves leading to development of somatic
symptoms or certainly in the mind leading to changes in the persons
personality.
Hahenemann provides, Here a very Ingeneous diagnostic Tests.
If the mental effect proceeds from one or more factors belonging to
psychological condition, that will be improved by sensible friendly
exhortations, consolatory arguments, serious representations and
sensible advice.
TREATMENT OF DIFFERENT TYPES OF MENTAL DISEASES:
In mental diseases originating predominantly from psychogenic
causes and if they are of recent origin psychotherapy should be taken
recovers to. Here is the scope for comparatively recently discovered
psycho-analytical method of Freud, Young and Adler (though the
actual details of these procedures could not have been possibly known
to Hahnemann but he anticipated their utility) clearly mentioned that
the patient is to be carefully encouraged to regain self confidence to
remold his life in the path of restitute where there had been moral
lipses. The physician to the patient should not only be his prescribed
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but also his friend, philosopher and guide to keep the patient to
resolve his complexes and revert to healthy growth and development
of his personality very often the cause of mental de-arrangement lies
in the failure on the part of the patient to adjust himself to the
situation he finds himself in and through his defect further in roads of
unsocial and immoral instincts which lay hither to dormant in this
sub-conscious mind, take place in the surface consciousness. These
develop in all the turmoils, dissociations and disintegration of
personality to render a man misfit in the world of actual reality.
Hahnemann also mentioned in fact note (13) to sec 222 that. It very
rarely happens that a mental or emotional disease of long standing
cures spontaneously and they are reckoned as cured person. But he
points out that these are only instances where internal dyscrasia
transfers itself again to the grosser corporeal organs. But are careful
scrutiny of patient even in that stage will reveal to the eyes of a
discerning Homoeopath many symptoms indicated. The presence of
psoric infection in the state of health of the individual and justifying
the need of instituting anti-psoric treatment on the individual
concerned. During Hahnemanns time mental cases were reckoned as
cured cases often suppressed to be possessed by evil spirits; and so all
the oppressive medical men could devise, were applied to the patients
in the Lunati Assylum. The credit of adopting humanity, methods in
the management of insane persons, certainly goes to Hahnemann. And
he with his phenomenal genius and clear institution anticipated the
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broad principles of psycho-therapeutic method which are necessary in
some cases solely; and also differentiated those cases which called for
judicious combination of psycho-therapeutic and anti psoric drug
therapy.
Rajan Shankaran 2 6 When you examine a remedy’s physical and
mental states you will find the connection so strong that it is difficult
to deny. The physical and mental state are unity, whatever mental
state is being caused, or at that time exists, must be in tune with
physical state. It is much easier to identify the state of mind rather
than the physical symptoms.
Herbert. A. Roberts. 2 7 The greatest force to rouse the evils of psoric
dyscrasia is grief and sorrow. There emotions seems to have particular
power in bringing out the exacerbation, and people under the
influence of grief and sorrow will often develop immediately same
acute sickness.
Psoric patients have much depression of spirit, if the patient is
a women, she will suddenly bush out crying, which relieves the whole
condition. When they get into this depressed condition everyone
knows of their troubles, because they are not accustomed to silent
grief. Melancholy patients on awakening from sleep have heart
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Homoeopathic Review
palpitation, and they become nervous and anxious, construction of
heart flushes of heat. They pass from depression of spirits into
moodiness, sulkiness or its of temper, then suddenly come out of these
moods and act like a entirely different mood.
Aph-210 patient with inherited latent syphilis are mentally dull,
heavy, stupid and especially stubborn, sulkem, morose, and usually
suspicious. They are always depressed, but in the depression they
keep their troubles to themselves and sulk over them, develop fixed
ideas. Which are not irradicated by any amount of explanation or
talk. Their mental powers are slow in reaction become melancholy,
self condemn. Like to be alone, get desire to escape from themselves
and as well as from others. In their slowness of comprehension,
thoughts vanish, they forget, hard to get back-night.
(211) Tubercular patient manifest the union of syphilit ic and
psoric dyscrocias.
(231) Sycosis coupled with psora, is basis of most criminal
insanity and of most suicide, and mentals > when warts and fibrous
growth appear > return or breaking up of old ulcers > return of acute
gonorrhoel manifestation.
P.N. Banarjee 1 8 It the soundness of if the real solution lies in making
the mind sound and healthy how can that be affected? In order to
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answer that question it is necessary first of all to find out why the
mind becomes diseased. The mind is diseased by the same cause as the
body. Because the mind is only a fine condition an immaterial spirited
condition of the material body; The material body is product of mind.
Psora, sycosis, syphilis disease our body and so do hey disease the
mood (39-40).
Psora, sycosis and syphilis can be removed from the system in a
permanent manner only by Homoeopathy. Psora mental disquiet for
no apparent cause moroseness, fearfulness P.No.280. Full of fear
restless and fearful. Sycosis selfish, suspicious syphilis is very deep
and incidious in its onset and night, He feels an irresistible impulse
for committing suicide and thinks only of possible means for relating
that impulse, forgets all have for life (305) psora is the outcome of
evil thoughts while the other two are the outcome of evil action.
J.H. Allen 2 8 Quite often mental symptoms rise and fell with the
general state of the health or through the influence of moon, or other
planetary changes by atmosphere or barometric risings and falling
now as the mentals, to a great degree, rules over the body. This is the
reason Hahnemann gave them such great value, as they were primary
or basic, and when a remedy was carefully selected, basing it upon the
mental phenomena, the cures where prompt and quite often permanent.
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Baldwin 2 9 The organon of the art of healing
(aph 210) The so caused diseases of the mind are the partial
exhibition of chronic sickness, the physical symptoms of which are
abscured by the manifestations of the abnormal mental state. (aph
211) The state of the patients mind and temperament, least of all,
should escape the physician’s acute observation. (aph 212) The state
of the mind and disposition is the principal feature of each disease.
Each potent medicinal substance are alter, perceptibly, the mental
condition and mad in its peculiar manner. (aph 213) Hence treatment
of disease would not be in accordance with nature of mind a
temperament were ignored when collecting the totality of symptoms
for any particular case. (aph 214) Mental diseases are curable only by
a remedy having a pathogenesis which is very similar to the totali ty of
symptoms of the sickness, including both mental and physical
symptoms. (aph 217) The remedy chosen should meet with the
greatest similitude the mental and physical symptoms. (aph 222)
Although a patient is relieved of an acute mental disorder by means of
non anti-psoric medicine, he should not be considered entirely cured.
(aph 223) Anti-psoric treatment should proceed, in order to avoid
subsequent and more serious attack, which will arise from slighter
cause and grow more difficulty curable. (aph 224) Mental
diseases induced by bad habits or depressions experiences can be
managed by admonition, sympathy or argument. If the malady is of a
constitutional character it will be made worse by such procedure.
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(aph 225) If the malady is the result of grief, mortification
vexation, insult, fear or bright it may profoundly affect the physical
health. (aph 226) These, if treated early, may be cured by physical
methods, gentle kind admonition appeal to reason, skillful deception,
or carefully regulated habits. (aph 228) Diseases of the mind and
temperament can be cured only by the Homoeopathic remedy
supplemental with proper physical hygiene and psychical regment
strictly enforced by physician and attendant. (aph 229) The patient
should be treated as if regarded rational, not reproached or
vituperated. (aph 230) Minute doses of Homeopathic remedies will
accomplish more than much allopathic medicine persistently
administered. One of the triumphs of Homeopathy in its successful
treatment of chronic mental diseases.
S.P. Dey 3 0 Mental diseases result from one maintaining causes e.g.-
facts of education, bad practices, corrupt moral, neglect of mind;
superstition of ignorance etc. can be treated sensible friendly
exhortations, consolatory arguments, serious representations, sensible
advice and deception in disguise. But if, even after removal of the
maintaining cause, the patient though relieved is not completely
cured, we are to think of some deep seated miasmatic treatment as
said before. Emotional disease arising from some emotional upset
e.g.- continued anxiety worry, vexation, wrong, bears etc. such cases
mind is primarily affected and the disease may subsequently be
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transformed into physical affection and in time may destroy the
corporeal health to a great degree.
Along with the above advice appropriate diet and regimen is to
be strictly followed. But the fundamental cause is most of these cases
is psora and unless radical anti psoric treatment is carried out, these
patients will not be cured completely and in future any slightest
emotional upset may result in a relapse of the same mental disease,
rather in an exaggerated form, may take the help of non-miasmatic
symptomatic medicine for the acuteness of the attacks followed by
anti-miasmatic treatment. Thus we see, emotional diseases arising
and settling primarily in the mind are rather easier to cure than those
transformed from corporeal diseases.
If we follow the directions of Hahnemann strictly, we can very
well tackle almost all mental diseases provided we get sufficient
scope and necessary amenities for the same we are anxiously waiting
for the days when Homoeopathy may get chance of proving its
efficiency and superiority in this highly important field of medicine.
Boericke Garth 3 1 If a person has a well marked mental symptom of a
drug and a well marked absolute symptom of another, the drug with
the mental symptom makes precedence over the other. The mind is
the highest form of cellular activity and changes here are always
individuals. Moreover, it is recent changes brought about disease
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which are significant, not the natural nature of the best. Thus, a
sunny disposition becomes markedly irascible during illness. Phobias
may develop apathy or the patient becomes sad and weeps. Again a
word of caution-do not “fish” for mental symptoms. They must be
very obvious to be reliable and then they take precedence over all
other types.
James Tyler Kent 3 2 The soul adopts the human body keeps that body
animated, keeps it moving, perfects its uses, superintendent all parts
and at all same time keeps the operation of operation of mind and will
in order.
Otto Leeser 3 3 In undertaking of a constitutional therapy there is
already the implication that the constitution is not an unalterable
state, this conception does not involve the restriction of constitution
to inherited properties but the dynamic definition presume a psycho-
somatic constitution in which the following connection of inherited
disposition up to the present disposition is regarded.
Dr. Samuel Hahnemann 3 4 explanation on treatment of so called mental and emotional diseases given in aph No 210 to 230.
Hahnemann considered mental diseases as one sided diseases of
chronic type effecting the whole psychosomatic entity. All diseases are
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psychosomatic in nature involves both psychic and physical sphere of
the patient. Mind and body are absolutely 2 separate entity, but they
form invisible whole, inseparable both under control of vital force.
Mental symptom assure great importance to select simill imum.
- Mental disease which develop independent of corporeal
(psychotic) diseases. Originates from emotional causes.
(reactive depression).
- Mental disease which appear suddenly mainly comprise of
manias can be considered sudden flaring up of dormant psora.
- Should be first treated with acute remedies helping in reverting
the psora to its former latent state and there by, relieving
patient. Permanent care and prevent recurrency treated with
antipsoric remedies. Prevents second attack precipitated by
slightest cause and thereby, making it more difficult to cure.
- (Aph 210) – Mental disease usually psoric in origin.
- (Aph 214) - For care of mental disease we should select a
medicine which is capable of proving morbid state both in body
a mind as similar as possible to the disease state.
- (Aph 223) – Hahnemann says that a chronic mental and
emotional disease of long standing which started from or which
started with corporeal diseases when treated with anti psoric
medicine, does much better than by allopathic medicine.
- Decide whether the mental disease has developed fully or not,
patient improves by sensible advice, Friendly exhortation than
the disease has not developed & should be so treated. But if
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they become worse then is a fully developed mental disease and
should be treated with symptomatic remedies.
E.A. Farington 3 5 (mental symptoms –534) Lachesis and other allied
remedies mental symptoms.
Lachesis – sadness, stupor.
Naja – Brings about depression of spirits etc. weak memory, natural
result of poison which is so powerfully depresses the mind.
Ant Crud – Depression of the spirits or ecstatic mood.
Lyco- Depression of spirits, angry, proud etc.
R. Gibson Miller and James Tyler Kent 3 6 In the highest ranks
must be placed all mental symptoms, and of these all symptoms of the
will and affections, including desires and aversions, also irritability
and sadness, are the most important, of less importance are disorders
of the intelligence, while those of memory rank lowest or the mental
symptoms.
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HAHNEMANN’S CLASSIFICATION OF DISEASESCLINICAL CLASSIFICATION OF DISEASES
LOCAL DISEASES
(According to Hahnemann)
INDISPOSITION SURGICAL DISEASES DYNAMIC DISEASES OR DISEASES PROPER
ACUTE DISEASES INDIVIDUAL ACUTE DISEASES
SPORADIC ACUTE DISEASES
EPIDEMIC ACUTE DISEASES
CHRONIC DISEASES
DISEASES WITH FULLY DEVELOPEDSYMPTOMS
DISEASES WITH BUT FEW SYMPTOMS
NON-MIASMATIC DISEASES
MIASMATIC CHRONIC DISEASES
ONE SIDED DISEASES
DISEASES WITH ONLY MENTAL SYMPTOMS
DISEASES WITH ONLY PHYSICAL SYMPTOMS
Sarkar B.K.25
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VIEWS OF DIFFERENT AUTHORS ON DEPRESSION /
MELANCHOLY AND ITS TREATMENT
Richard Huges 3 7 Melancholia which is out of all proportion to
any bodily disorder on which it is engrafted; which is traceable; to
inheritance or acquirement to psychical cause; and which requires
remedies or another group. I am glad to find that Dr. Talcott confirms
my recommendation of Ignatia as the best medicine in recent cases.
He emphasized the suspension of the power of weeping as calling for
it, where also “ the grief that cannot speak “ Wrispers O’ erfraught
heart, and bids it break. (Some cases illustrated the sphere of
Arsenicum, Aurum and pulsatilla in the melancholia, by Dr. Junge,
may be read in J.B. H; S, iv., 137. North American Journal of
Homoeopathy: Feb; 1837.
Where the patient weeps overmuch, and the physical state is of
the Anaemic, atrophic state; characteristics of it; Natrum muriaticum
may take the place of Ignatia.
In more confirmed cases over choice generally lies between
Aurum and Aurum and Aresenicum. Dr. Talcott has been disappointed
in the former metal; but this is probably because his hospital patient
are in to low a physical condition to render it suitable. The testimony
borne to it by Hahnemann himself and several of his followers is too
strong to be neglected. It is ; as you know, when suicidal tendencies
manifest themselves has so much repute among us; and I hare
suggested that its mental State, though urgently demanding treatment
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on its own merits, is one primarily engrafted on hepatic or testicular
disease. But while Vindicating the traditional claims of Aurum, I fully
subscribe to all that Dr. Talcott has written in praise of Arsericum Dr.
Morris Butler – who worked with Dr. Talcott opines. Seratrunalb in
melancholia Attonita. Melancholy characterist ic of opium eaters.
Samuel Lilienthal 3 8 Melancholia cum stupore, attonita: Apis,
Bapt, Dig, Gels. Oleand., Op., Veratr. Alb.; or Arg. nit Ars., Chin .,
Cimicif., Crot. tigl. , Ust.
Melancholia religiosa: Ars., Aur., Croc., Lye. , Melilot. , Puls.,
Sil. , Stram., Sulph., Veratr. , Zinc.
Anxiety as if the had committed as crime: Alum, Ars., Chel.,
Cocc., Cycl., Dig., Ign., Merc., Sulph., Veratr.; as if persecuted:
Chin., Lach., Sulph., etc.
Anguish and despair: Acon., Amb., Calc., carb., Ign., Lach.,
Lye., Puls., Sarsap., Vat., Vertr.
Jealousy: Apis, Hyosc., Lach; hate against loved ones: Agn,
Fluor. Ac., Sep.; avarice: Calc, fluor., Lys.; wishes to be alone:
Acon., Bell. , Coca, Dig., Rhus.
Suicidal tendency: Ars., Aur., Ant. Crud., Caps., Carb. v.,
Chin., Merc., Naja, Nux v., Puls., Psor.; Agn, cas., Alum.; drowning:
Bell., Dros., Helleb., Hyosc., Puls., Sec., Veratr.; hanging : Ars.;
shooting: Ant. Crud., Carb. v.; to throw himself from a height :
Bell.; hopelessness: Arn., Aur., Cham., Cocc., Helleb, Hyosc., Ign.,
Op.; sadness: Abies, Acon., Caust., Cepa, Cimicif., Ign., Natr. m.
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Variableness: Alum., Fer., Ign., Plat. , Puls., Sep., Sulph. ac.,
Zinc.
Abrotanum. – Great anxiety and depression, gloomy and
desponding (abdominal); ill- natured, irritable and peevish, feels as if
she would do something cruel; no humanity; easily tired out by
conversation or mental efforts; indolence and aversion to physical
exercise; head week, can hardly hold it up; face wrinkled old pale.
Agnus castus. – Sexual melancholia; atonic condition of
sexual organs; hopelessness; patient thinks there is no use to do
anything, as death is sure to come soon.
Ailanthus. - Low spirited. Continued sighing, restlessness,
confusion of ideas; electrical thrill, starting from the brain, running to
the extremities; perfect indifference to what might happen.
Alumina. – Intolerable ennui, time passes too slowly; depressed
and lachrymose; sad thoughts in the morning, feels joyless and
comfortless in the morning on waking; trifling things appear
insurmountable; dread of death, with thoughts of suicide; seeing
blood on a knife, she has ideas of killing herself , though she
abhors the thought; no desire to do anything, especially something
serious.
Ambra grisea. – Melancholy, sits for days weeping, with great
weakness, loss of muscular power and pain in small of back;
constipation, sadness; sleeplessness after business embarrassment; the
presence of other people makes her feel worse.
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Anacardium orient. - Everything appears as in a dream;
excessive forgetfulness, even of recent events; fixed idea that mind
and body are separated that strange forms accompany him; a slight
offense makes him very angry, curses and swears, break out into
personal violence; want of moral feeling; depravity; ungodliness;
inhumanity; feels as if he had two wills, one commanding to do
what the other forbids; he is separated from the whole word; and
having lost all confidence in himself he despairs of accomplishing
anything. Melancholia after childbed.
Antimonium crud. – Loathing of life; sorrowful and irritable,
anxious in relation to present and future condition; ecstasy and
exalted love, with great anxiety about his fate and inclination to shoot
himself; < when waling in moonlight; sexual desire and erections
when getting warm in bed.
Antimonium tart.- Apathy and indifference; even death would
be welcomed; hopeless and despondent, inclined to violence; children
get angry, weep and cry.
Argentum nit.- Loss of memory; lies with closed eyes,
shunning light and conversation; he cannot find the right word, hence
falters in speech; feels that all his undertakings must fail, is lost
beyond hope for this world, in neglected and despised by his own
family; all desire for labor lost; objects to whatever is proposed, he
seems utterly bereft of all power of will; agoraphobia and
hypochondriasis.
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Arsenicum.–Profound exhaustion after long wasting
diseases; physical disease and consequent exhaustion lead to self-
mutilation and suicidal ideas; gloomy disposition of mind with
religious apprehensions; attacks to anxiousness, especially at night, or
in the evening in bed, obliging one to rise, with oppression and
difficulty to breathing; anxiousness at the heart, with fainting and
could trembling; conscientious scruples, as if having offended
everybody and could not be happy; and dread of being alone; great
dread of death and still inclination to commit suicide; sensation as if
warm air were coursing up the spine into the head; burning neuralgia
with agony and great restlessness, and this anxiety drives him from
one place to another.
Asafoetida. – Anxious sadness and apprehension of dying, is
afraid to be alone; unsteady and fickle, cannot preserve in anything,
wants one thing and then a another; walks from one place to another;
physical and mental over sensitiveness; globus hystericus,
nymphomania.
Aurum met. – Woefulness and dejection, with longing for
solitude; solitude in regard to the loss of love and respect of others,
with deep grief and weeping; religious solicitude, with weeping and
praying, has no confidence in himself; great longing for death, as he
thinks himself unsuited in this world, weeps in the evening and wishes
to die; feels hateful and quarrelsome, without hope; staring dreary
look; wavering uncertain gait; insomnia offensive, breath, reddish
tongue and copious salivation; loss of taste, diarrhoea and
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Homoeopathic Review
constipation alternate; rush of blood to head, roaring in Ears; motes
and sparks be fore eyes; all symptoms > in fresh air Hepatic and
testicular (atrophy) disorders, syphilo-mercurialism; spasmodic
asthma; climaxis; puerperal melancholia.
Baptisia. - Melancholia cum stupore; mentally restless, but
too lifeless to move; indisposed to give vent to his thoughts, want of
power and perfect indifference to do anything, inability to fix the
mind on any work; mind wanders as soon as his eyes are closed;
marked changes to the vital fluids; degeneration of tissues; high
temperature; anxious, frightened look; foul breath; dry, parched
tongue; head heavy as if he could not sit up.
Belladonna. – Dejected and discouraged; disgust of life, < in
open air, with inclination to drown himself; continual moaning and
sighing, even during sleep, and restlessness drives him out of bed;
anxiety and great anxiousness, < evening, headache, red face, bitter
taste, sweat and longing for death; dread and tendency to start easily,
with mistrust and tearfulness; solicitude about sudden death; of
putrefying while yet alive. Of being poisoned and everlastingly
damned; suicidal tendencies in patients suffering from acute violent
alcoholism; persistent insomnia, leaving the mind extremely dull,
stupid, slow to act, indifferent and pathetic; nothing produces an
impression.
Bismuth. – Anguish, at times he sits, then walks , then lies
down, never long in one place, he is morose and discontented with his
condition and complains about it; solitude is unbearable; pressure
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like a load in the stomach; great debili ty, languor, prostration;
restless, unrefreshing sleep.
Bromium. Great despondency, looks constantly in one
direction without saying anything; she does not feel as she generally
does, an does not know why; fullness in head and chest; much pain in
left hypogastric and illac regions, especially before menses;
carcinoma mammae; swelling of testicles.
Bryonia.- Great depression and anxiety, with fright, fear and
apprehension of future trouble and misfortune; irritabil ity, weeping
and moroseness; mental exhaustion and confusion of mind; sticking,
jerking, throbbing headache; marked inactivity of liver or rheumatic
diathesis.
Cactus grand. – Melancholia, particularly in women, with sensation of stricture around heart; unconquerable sadness, fear of death (Acon); cries without cause but< from sympathy; often awakes in a fright, but cannot tell the cause of alarm.
Calcarea arsen. .- Mind much depresses with great anxiety about still greater evils in the future; the slightest emotion causes palpitation o heart (Lith); dull, stupefying headache in different parts of head, but especially above and behind ears; desire for wine and liquors.
Calcarea carb.- Malnutration and malassimilation; fears she will lose her reason and people will observe her mental confusion; feeling of oppression, with heaviness of lags, trembling of body and frequent weeping, < evening and when admonished; grief and complaining about old offences’ dread of solitude which is unbearable; dread of being seized by misfortune, on account of her ruined health; loathing of work, with irritability; great tendency to be frightened, the least noise, the most trifling unexpected occurrence fatigues and causes trouble; does not like to talk.
Calcarea fluor .- Unusual tendency to look at the dark side of everything; feeling of unnecessary anxiety about everything; disposition to set a higher value on money then natural to him; avarice (Lyc.) thinks he will come to want or would soon be running financially behind.
Cannabis Ind. – Overestimation of time and space; nervous depression and distressing fear of an imaginary character, nervous organization; constant fear he would become inane; horror of darkness, moaning and crying; anguish, with great oppression, > in fresh air.
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Carbo an.- Sorrowful feeling of dereliction, faintheartedness, desire for solitude, sad thoughts and great tearfulness; despair day and night; timidity and tendency to start.
Caulophyllum. – Melancholia following long-continued menstrual irregularities and uterine and disorders; weakness of mind and memory; fretful and irritable; insomnia and restlessness during menses; tremulous weakness felt over entire body.
Causticum. – Mental ailments from long – lasting grief and sorrow; excessive sympathy for others, always afraid others might takes harm, no desire for life on account of that constant dread and anxiety; timidity about the future or as if he had committed a crime; great sadness, with weeping on the slightest provocation; looks at the dark side of everything, especially before and during menstruation, which flows only in daytime, none at before and during menstruation, which flows only daytime, none at night; deep yellow complexion, sour sweat.
Chilidonium.- Anxiety, allowing no rest at nay employment, as if she had committed a crime; fear of getting crazy, with restlessness and heat; distaste for mental exertion or conversation; forgets what she wants to do or has done
China.- Mental depression as reflex of general lowered vitality; low spirited, despondent and tired of life, with suicidal tendencies; great sensitiveness; easily moved to tears by the least contradiction; indifference and apathy with obstinate taciturnity; weakness and exhaustion after the least exertion, > in the evening and at night; nocturnal dread of dogs and other animals; desire for solitude.
Cicuta.- Anxious thoughts about the future, feels sad; excessively affected by sad stories; weeping, moaning and howling; fondness of solitude; great dislike to society; indifference and apathy; disposition to be frightened. Mistrust and shunning of the male sex (Bar).
Cimicifuga.- Deep melancholy, with sleeplessness; a heavy black cloud has settled over her, so that all is darkness and confusion, while at the same time it weights like lead upon her heart; perfect indifference; taciturnity; takes no interest in house hold affairs sights and moans and is suspicious of everybody; brain feels too large for the cranium, a pressing from within outward; sensation of enlargements of the eyeballs, which feel as, if they would be presses out of the orbits; foul breath; faintness and goneness in the epigastrium; prolapsus uteri; nervous exhaustion from the least exertion; chorea, puerperal melancholia.
Coca.- melancholy from nervous exhaustion; bashful, timid , ill in society; peevish; delight in solitude and obscurity.
Cocculos.- Great sorrowfulness, with constant inclination to sit in a corner buried in thought, and to take no notice of anything about him; discontented with himself and still easily offended; great anxiousness as if he had committed a crime; confused feeling in the head, especially after eating spasms and dysmenorrhoea; excessive prostration, as if it were impossible to make any exertion.
Colchicum-Arthritic melancholia with suicidal thoughts; peevish and dissatisfied; want of memory.
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Colocynthis.- Absence of religious sentiments; apathy with lassitude, cannot bear the society of persons he is intimate with; laconic mode of expression; no disposition to talk; dissatisfied with everything; consequences from indignation and internal gnawing grief over his imaginary or real troubles.
Conium.- the great inhibitory remedy of the sexual passions; excessive nervous prostration, with vertigo when lying down and when turning over in bed; great concern about little things, and becomes easily excited; dreads being alone, and still avoids society; praecordial anguish; superstitious and full of fear, with frequent thoughts of death; loss of memory; alternate fits of silent depression and quarrelsome liveliness; and mood serious; unsympathizing, from indolence and want of proper will -power; cannot endure any kind of excitement, it brings on mental and physical depression, with weakness; confused feeling in head, often sits lost in thought.
Crocus.- Fearful, apprehensive sorrowfulness, even of a religious kind; is not fit to live; alternations of excessive happiness, affectionate tenderness and rege; takes everything in anger and suddenly repents having injured others; restless, anxious, timid; gay extravagance and liveliness alternate with sorrowful dejection.
Crotalus cascavella.- Insomnia, great sadness; her thoughts dwell on death continually, especially when alone; dreams about the dead, when she falls asleep.
Crotalus horridus.- Timidity, fear, anxiety; weeping or snappish temper, cross; irritable, infuriated by the least annoyance; sadness; her thoughts dwell on death continually; twitching and nervous agitation; lethargy, loss of co-ordination; incipient stage of senile dementia.
Croton tigl.- Melancholia attonita; feeling as if one cannot think outside of himself , feels all pent up inside and no chance for the thoughts to floe outside; feeling of anxiety as if some misfortune would befall him; morose, dissatisfied.
Cuprum.- Mental and bodily prostration after overexertion of mind an loss of sleep; anxiety, fear of persecution, is in despair, with very difficult breathing and faint felling; skin cool, covered with cold sweat; unconquerable sadness and restlessness, as if some misfortune were approaching; weeps often, shuns the sight of people, seeks and loves solitude; anxious concerning death, which she believes near an inevitable.
Digitalis.- Great anxiety, depression and dread of the future, with sadness and weeping,< about 6 P . M . and by music; morose, irritable and gloomy; weakness of memory, mind dull and confused; sleep unrefreshing, with frequent waking; aguish, which seems to proceeds from epigastrium; weakness and exhaustion; slow pulse; relief of stupor by weeping.
Elaps coral.- Excessive horror of rain ; dread of being alone, as if something would happen; violent headache when the desire for food is not immediately satisfied, < from fruits or cold drinks; irregular menses, weight in vagina with violent itching; weakness and trembling.
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Eugenia jambos.- Desires fro solitude, mental depression, loss of memory; his mind seems to brighten up after urinating, feels depressed before and shivering after urination.
Ferrum.- Mind exceedingly oppressed; great solicitude about those belonging to him, with constant thoughts of death; anxiety as after committing a crime; from slightest cause anxiety, with throbbing in pit of stomach; excited by slightest opposition, everything irritates and oppresses her; anaemia and debility with congestion to head and chest.
Graphites- Herpetic constitution; gloomy and low-spirited; great inclination to grief, even to despair, propensity to feel himself unhappy, with thoughts of deep grief and weeping; timid restlessness, < mornings; oppression about heart, with uneasiness in stomach, great anxiousness as if after the commission of a crime or as if a misfortune impended, with hot face cold extremities; anxiety when seated at work; repugnance to labor; venous persons. With disposition to obesity.
Helonias.- Mind exceedingly dull and inactive; desires solitude: irritable, faultfinding, cannot bear the least contradiction, all conversation is unpleasant; pressure from within upward to the vertex, aggravated by looking steadily at any fixed point; atonic condition of the sexual organs.
Helleborus.- Quiet, placid melancholy, with sighing, moaning and dread of dying; feels unhappy in presence of cheerful faces; anxiousness about the heart, which prevents him from resting anywhere; ameliorated by vomiting; slow comprehension; obstinate silence; homesickness. Repercussion of exanthemata.
Hepar.- The patient is impelled by unaccountable attacks of internal anguish, which sometimes comes on quite suddenly, to attempt suicide (Alum); chronic abdominal affections; excessive from abuse of mercury; dejected, sad, fearful; repulsive mood and desire to be left alone; dementia, with stupidity, sits silent and speechless in a corner; violent outbursts of passion, so that he does not wish to see the members of his own family; hasty speech and hasty drinking.
Hyoscyamus.-Nervous irritability without hyperaemia; malencholy with despair and propensity to drown himself (Bell) and total indifference to food and drink; reproaches of conscience; dread of being sold, poisoned, bitten by animals; syphilophobia; jealousy with attempt to murder, aversion to mankind, mistrust and indolence; hyperaemia cutanea, wants to go naked, with loss of all shame; constant absurd talking or muttering to himself .
Ignatia .- Tears wept inwardly; suicidal desire to be released from what seems to be a perpetual burden of sorrow; desire for solitude so that he may still more nourish his inward grief; great anxiousness at night or awaking in the morning, with taciturnity; fear of thieves on waking after midnight; timidly and fear of contracting disease; aversion to any amusement; vacant gaze, sits quietly; face distorted, earthy, pale and sunken; no desire to eat or drink; weak memory; heaviness of head, losing hair in one side; voice low, trembling; staggering walk; general weakness; cold feet, mostly evening; sexual desire with impotence;
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menses scanty, black, of a putrid odor; increased stools and urine; recent cases.
Indigo.- Patients feels very gloomy, taciturn, timid, is tired of life, spends his nights crying; epileptic convulsions; flushes of heat from abdomen to head; sensationas if the head were tightly bandaged around forehead; the epileptic fit always commencing with dizziness; undulating sensation through the whole head from behind forward.
Iris vers.- Biliousness, despondency, low-spirited, easily vexed; confusion of mind with mental depression; habitual headache from gastric or abdominal causes.
Iodum.- Melanecholy, must keep in motion day and night; brain feels as if were stirred up, feels as if it were stirred up, feels as if going crazy; shunning and fear when any one, comes near, particularly the physician; excessive excitability and sensitiveness; expects an accident from every trifle.
Kali ars. – Scolding, morose, retired, quarrelsome and discontented; jealous, indifferent to everything, scarcely answers questions, or replies in a peevish tone; eyes have a fixed look; face frightened and anxious.
Kali bichrom.- Anthrophobia; weakness, aversion to business, indifference, fretfulness, irritability, anxiety arising from chest; distress in stomach; averse to motion, inclination to lie down.
Kali brom.- Imagines he is especially singled out as an object of Divine vengeance, thinks all her friends have deserted her, is full of religious delusions and a feeling of moral deficiency; nervous restlessness, can not sit still, must move about or otherwise occupy himself; insomnia; frequent shedding of tear; low- spirited, childish giving way to her feelings; indifference and almost tired of life; profound anaemia.
Kali carb.- Alternating mood, at one time good and quiet, at another excited and angry at trifles; constantly in antagonism with herself , frequently despondent; frets about everything, peevish, impatient, contented with nothing; great aversion to being alone.
Kali hydr.- Very great irritability and unwonted harshness of demeanor; his children, to whom he is devotedly attached, become burdensome to him; very passionate and spiteful temper; inclined to sadness and weeping, with constant apprehension of impending evil.
Kali phos.- Religious melancholia with fear of hell; refuses food and drink and tars everything; hyperaesthesia of senses with anaemic weakness and failure of strength as after mental overstrain, depressing emotions, or from exhausting drainings affecting nerve-centres of cord; hysteria with globus.
Lac caninum.- Thinks she is looked down upon by everybody, that she os of no importance (Pallad); doubts her own ability and success; weeps easily, exceedingly nervous and irritable.
Lac defloratum.- Depression of spirits, does not want to live and does not want to see or to talk to any one; n fear to death, but is sure to die.
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Lachesis .- Quiet sorrowful lowness of spirits relieved by sighing; repugnance to society and dislike to talk; solicitude about the future with disgust of life; inclination to doubt everything; mistrusts and misconstrues everything in the worst way; indolence, with aversion to every kind of labor and motion; insane jealousy.
Laurocerasus.-Indolence and Indisposition to either physical or intellectual labor, so that patient becomes disgusted and tied of his life; fear and anxiety about imaginary evils; disposition to sleep; titillation in face, as if files and spiders were crawling over face; want of energy of vital powers, no reaction, a paralytic weakness.
Leptandra.- hepatic derangement.- Languid, tied feeling, with great prostration; gloomy, desponding; drowsy; physically and mentally depressed.
Lilium tig.- Indecision of character, and depends entirely upon others; dislikes being alone, but has no dread of being so; opposite mental states , feel nervous, irritable, scolding, and still in a pleasant humor; constant inclination to weep; has to keep very busy to repress sexual desires; great bearing down in pelvic regions, as if everything from the chest down would fall out; the heart feels as if it were full of blood, with depression of spirits and apprehension of impending evil; blurred vision.
Lithium carb.-Disposition to weep about his lonesome condition; difficulty in remembering names; sensation of entire helpless, especially at night.
Lobelia infl.- Fear of death from difficulty of respiration; restless sleep, with anxious and sad dreams; excessive weakness of the stomach, extending into the chest, with oppression of chest; sudden shocks through the head.
Lycopodium.- Want of self- confidence; fear of phantoms in the evening, with anguish; pusillanimous, nervous irritable and peevish; seeks disputes, which is followed by supreme indifference hypochondriasis; confusion of thoughts and forgetfulness, using wrong words, supposing himself to be at two places at once; fear of going to bed in the evening, is sure to hear somebody in the room; satiety of life, particularly mornings in bed; dread of men, wants to be alone or dread of solitude with irritability; misanthropy with miserly disposition, files even from his own children, abdominal and mental torpor.
Lyssin (Hydrophobium) .- Cannot rid himself of the tormenting idea that something terrible was going to happen to him; fits of abstraction, he takes hold of wrong thins, does not know what he wanted; use words which have but a remote similarity of sound; two distinct trains of thoughts seems to be operating at the same time; imagines to be abused by others and tries to defend himself .
Melilotus.- Religious melancholia with weeping and indolence; reluctant to rise in morning, sits and does nothing; face always hot and flushed, throbbing of carotids; constipation; > by nosebleed or any other haemorrhage.
Mercurius.- Inexpressible pain of soul and body, anxious restlessness, as if some evil impended, worse at night, with praecordial
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anguish; sweat of the hands and heat of the face; disgusted with himself, has not enough courage to live; constant suspicion, considering everybody hid enemy.
Murex. - Great depression of spirit, she considers himself hopelessly ill, goes to bed and remains there; great debility of the muscles; sinking of stomach; sensation of dryness or constriction of uterus.
Mygale. - Constant talk about business, restless at night; despondent with anxious features; tremulousness of whole body in the evening; nausea, with strong palpation of heart; dimness of sight; general weakness and fear of death.
Naja tripudians.- Suicidal insanity, broads constantly over imaginary troubles; sleep full of frightful dreams, and wakes with dull pain in the head, and fluttering of the heart; uneasy dryness of the fauces; grasping of throat, with sensation of choking, and lividity of the face.
Natrum carb.- Aversion to man and society; sadness, depression of spirits, head feels stupefied if he tries to exert himself; avarice (Lyc, Calc,fluor.); restless, with attacks of anxiety, especially during a thunder-storm, playing piano for a short time causes painful anxiety in chest, trebling of body and weariness; must lie down; phlegmatic indolent disposition, with repugnance to speaking, to work, or any occupation.
Natrum mur.- Crowing of gloomy thoughts which recall insults long since suffered, with want of self- reliance and palpitation of heart; great inclination to weep, and condoling only makes things worse; timid inquietude about the future, with inclination to remain for hours buried in thought; indifference from hopelessness and mental languor, wishes only to remain quiet and to sleep; sallow complexion; excessive sadness during menses, with palpation and morning headache; he losses flesh though living well.
Natrum sulph.- Music unbearable, makes him melancholic, even of a lively kinds makes him weep; suicidal tendency, must exercise restraint, attended with wildness and irritability, due to gastric, bilious conditions, < in we weather and damp dwelling, and > in warm, dry weather.
Nitric acid.- Dread of contentions, quarrels and lawsuits; frequent sorrowful thoughts of past events; fearful and easily frightened; disgust of life , with longing for death, which, however, is dread; reserved and does not wish to talk.
Nux vomica.- Mental recklessness, desperation and hot, irritable temper. Wants to kill those she loves best; nervous excitement and mental worry, inability for mental work; taciturn, desire for solitude; afraid he might not have enough to live on and great propensity to end his existence; abdominal plethroa and constipation.
Oleander.- Absentmindedness and slowness of perception; utter indolence and aversion to do anything, will not dress or eat; cannot bear the slightest handling and becomes greatly enraged if touched by any one; breathing oppressed and heavy; head hanging down; itching of
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scalp with constant tendency to scratch the head; rumbling and flatulence of bowels, with hard difficult stool; urine brown, normal in quantity.
Opium.- Hallucinations of specters and animals with great fear; imagines parts of body very large; imbecility of will. As if annihilated.
Petroleum.- Fear of death; great irresoluteness, no desire for work and dissatisfied with everything; sensation as if there were a cold stone in the heart; emaciation; profuse night- sweats; mucous diarrhoea.
Phosphoric acid.- Chronic and long- lasting effects of grief, with night- sweats from sheer exhaustion; heavy pressure on top of lead, as if a great load lay there; indifference and unwillingness to speak; homesickness, with inclination to weep; hysteria during climaxis.
Phosphorus.- Sadness recurring regularly at twilight, anxiety and irritability; melancholy, only> by vehement weeping, depression with foreboding of calamity; fearfulness and restlessness, which seems to arise from left chest and attended by palpitations; prostration from least unpleasant impression; indifference, even towards his own children.
Platina,- Melancholia activa, the mind rises in defiant and distorted superiority over vexation and sorrow; personal demonstrative apprehension, alteration of weeping and boisterous mirth; indifference to others, but anxious about herself , ill- humor, dizziness, she dare not move her eyes; <in daytime, with palpitation of heart and internal and external coldness, except the face,> in open air ; mental symptoms associated with hysteria and disorders of sexual organs.
Pulsatilla.- Religious melancholia which finds consolation in prayers; grief and sorrowful timidity on account of his worldly and eternal affairs; anxious and weary of life, sad and gloomy, easily bursting into tears; dissatisfied; very easily frightened; frequent profuse epistaxis; anxious dreams with praecordial anguish and ideas of suicide; mild, yielding disposition, clinging to others and seeking consolation; earthy, dark ring about eyes; dislike to bread and meat; nausea and bitter, slimy vomiting, f lushes of heat, pale face and cold hands.
Senecio.- Inability to fix the mind on any one object for any length of time; depression of spirits, alternating with cheerful mood; meditative, but don’t know of what he thinks, especially in the evening; hysteria; great sleeplessness, or sleep with vivid unpleasant dreams.
Sepia.- Organic disease of female genital organs(Lil. Functional); full of despair, down-hearted, with suicidal ideas; great disinclination to work and motion; sadness, worrying about her health and the future, with frequent attacks of weeping, and indifferent about the health or affairs of her own family;< evenings and in open air; f its of involuntary laughter and weeping; dread of being alone; very irritable, inclined to vehement; weak memory, difficulty in expressing her thoughts and dislike to mental labor; relief by violent exercise, as walking; indifference to her household affairs, to which she was formerly attentive.
Silicea.- Want to vital warmth, even when taking exercise; secret disgust for life; faint- hearted, anxious mood; stings of conscience, as if he had committed a crime, worse during growing moon.
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Staphisagria.- Inwardly gnawing grief and anger, he looks at everything from the darkest side, with desire to die; disinclination to work and to think; dread of the future and dread of being constantly pursued by others; a sorrowfulness ending in paralysis of the intellect; constant chillness, even in summer, vertigo and sensation of seasickness; scurvy.
Stramonium.- Melancholy, with desire for society and sunshine; fear and trembling when alone or in darkness; welcomes the thought of death when alone; indomitable rage, with great desire to bite and tear everything to pieces.
Sulphur.- Religious melancholy; reproaches of conscience, despair of salvation, much weeping; abdominal venous plethora, venous lethargy; inclination to consume hours in doing nothing; does not take any interest in anything; pusillanimity and disgust for life, being too lazy to rouse himself up, and too unhappy to live, wishes to be alone, as soon as he sees anybody, he feels a weakness all over, but worse in stomach, followed by sweat on head and flushed face.
Tabacum.- Despondency, gloomy, apprehension of sudden death; fear of death, yet attempting suicide; great timidity, fear to undertake what he has frequently done; difficulty in concentrating his mind for any length of time on one subject.
Tarentula Hisp.- Consciousness of unnatural state of mind, hence despondency, sadness, moral depression and relaxation with complete loss of memory; fear of contracting disease(Hyosc.); mental chorea; hyperaemia and hyperaesthesia of female sexual organs.
Veratrum alb.-Religious melancholy; with reproaches of conscience, talks a great deal about religious things; suicidal melancholy; this conditions frequently ends in raving mania, with cursing and scolding; endeavors to escape; bites everybody, and tears everything that offers opposition; foolish imaginings; placid sadness, with weeping, discouragement and despair; apprehension of misfortune; conscious about his unworthiness; despair about his position in society; very taciturn; sudden paroxysms of sinking of cerebral innervation, characterized by sudden loss of power to control his movements; melancholia; cum stupore, mind dull and stupid, with obstinate taciturnity.
Veratrum vir .- Great depression of spirit; mental confusion and stupefaction; will not see her physician, fears of being poisoned; sleepless, can hardly be kept in her bedroom; cerebral hyperaemia with coldness of whole body.
Anxiousness: Alum., Anac., Ant Crud., Ars., Aur., Bell. , Caust., Con., Chin., Graph., Hyosc., Kali carb., Lach., Laur., Merc., Natr. carb., Natr.m., Nux. v., Puls., Sep., Staph., Veratr.; of conscience: Alum., Amm carb., Ars., Aur., Carb.v., Caust., Con., Graph., Hyosc., Ign.,Merc., Nux v., Puls., Sil. , Veratr.
Dread of being condemned: Alum., Amm., Ars., Aur., Bell. ,Carb. v., Caust., Con., Graph., Merc., Nux. v., Merc., Puls., Sil. , Sulph., Veratr.; Of everlasting damnation: Alum., Anac., Ant Crud., Ars., Aur., Bell. , Caust., Con., Chin., Graph., Hyosc., . , Lach., Laur., Merc., Nux. v.,
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Puls., Sil. , Sulph., Stram., Veratr; of misery: Anac., Ant Crud., Calc., Caust., Lach., Natr. carb., Natr.m. ,Phos., Sep., Sulph. Staph.; of pursuit by enemies: Anac., Aur., Bell. , Cic., Con., Hyosc., Helleb., Lach., Lyc., Merc., Natr., Nux. v., Puls., Rhus; of being poisoned: Bell., . , Hyos., Rhus; of being murdered: Calc., Hyosc., Rhus, Staph.
Easily frightened: Acon., Alum.,Ant., crud., Bell. , Calc., Caust., Cic., Helleb., Ign., Lach., Merc.,Nitr.ac., Nux. v., Plumb., Puls., Stram., Veratr.
Groaning and moaning: Acon., Amm.carb., Bell. , Chin., Cocc., graph., Helleb., Ign., Lach., Merc.,Nitra.ac., Nux. v., Plumb., Puls. Sep., Stram . , Veratr.
Indifference: Arn., Ars., Bell. , Calc., Chin., Cic., Caust., Croc., Helleb., Ign., Lach., Merc., Natr .carb., Natr .m., Nitra .ac., Phos. Ac., Plat., Puls., Sep ., Sil. , Staph., Stram., Veratr. ; to biusiness : Arn., Sep ., Stram. ; to family: Lyc., Phos., Plat., Sep.
Distinguish life: : Alum., Ant., crud., Arn., Aur., Bell. , Caust., Con., Chin.,Hep., Hyosc., Lyc., Merc., Natr .carb., Natr .m., Phos.., Plat., Sep ., Sil. , Staph., Stram., Sulph., Thuj.
Repugnance to society: Acon., Amb., Anac., Arn., Bell. , Cic., Con., Hyosc., Lyc., Natr .carb., Puls., Rhus.,Sulph.; will not talk: Alum., Ambr., Ars., Bell. , Calc., Chin., Cic., Ign., Lach., Merc., Natr.carb., Nux .v., Phos. ac., Plat., Plumb., Puls., Staph.,Sulph., Veratr.
Praying, frequent: Aur., Bell. , Natr.m., Puls. Stram. Veratr.; religious fear: Alum., Amm., Ars, Aur., Bell. , Caust., Con., Croc., Graph., Lach., Lyc., Merc., nuxv., Puls., Stram., Sulph.
Solitude, aversion to: Ars., Calc., Con., Dros., Lac can., Lyc., phos., Stram.; Love of: Aur., Bell. , Chin., Cic.,cupr., Graph., Ign., Led., lyc., Nux.v., Rhus.,Sep.
Obstinacy: Acon., Alum., Amm., Anac., Calc., Caps., Caust., Chin., Dross., Kalicarb., Lyc., nitr. Ac., Nux v., Phos.ac. Phos sil. , Sulph.
Tearfulness and weeping: Acon., Alum., Anac., Arn., Ars., Aur., Bell. , Caust., Cocc., Con.,Cupr., Dig., Dross., Graph., Hep., Lan can., Lach., Lyc., Merc., Natr .carb., Natr.m., Nitr.ac., . Nux. v., Phos. ac., Phos Puls., Pallad., Plat., Sep., Staph., Stram., Veratr.
No inclination to work: Alum., Amm., Anac., Arn., Aur., Calc., Caust., Cupr., Ign., Lach., Merc., Natr .m., Nitr .ac., Nux .v., Phos., Plumb., Puls., Rhus., Sep., Sil. , Staph., Sulph.
J.T.Kent 3 9 Sadness First grade Remedies .- Acon., Ars., Ars I., Aur., Aur.m., Calc., Calc ars., cals., Carb. an., Carb.s., caust., Cham., China., Cimic., Crot.t. , Ferr., Ferr.Iod., Gels., Graf., Hell. , Ign., Jod., Kali Br., Kat p., Lach., Lept., Littig., Lyc., Merc., Mez., Murx., Nat.a., Nat.c., Nat.m., Nat.s., Nit.Acid., Plat., Psor.,puls., Rhus., Tox., Sep., Stann., Sulp., Thuj., Verat., Zinc.
Morning:- Lach.Waking on : - Alum., Lach.Evening :- Aur, Puls., Nit.A.Errors of Diet:- N.CarbMenses:- N.mur., Puls., Stann.Stories- Cic.
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Perspiralion :- Con.Warm room- Puls.
J.K.Kent 4 0 – Proclaims efficacy of following remedies. Alumina – very sad, constantly sad, Incessantly moaning, groaning,
worrying fretting and in during, wants to get away from place, full of fears < morning, waking. Sadness and weeping on waking in the morning.
Aur. Met. - Depression of spirits that there is absolute loss of enjoyment in everything. You take away mans hopes and he has nothing to the for he then wants to die. Self- condemnation, self- criticism. Future looks dark. In most profound states or melancholy and depression where sits silent and says nothing. A/F disappointment have, fright, grief, contradiction.
Graphitis. - Mental depression extreme., and is made worse by music; her sadness is so great that she thinks only on death and salvation. Grief and vexation cause a recurrence of all her distressing mental sufferings, distress in morning great active till midnight prevents sleeps distress in morning.
Ignatia. – Who suffers from grief. Headaches, sleepless, weeping spell unable to control herself . Grief torn her to pieces in sensitive, Delicate; emotional women; hysterical.
Nat mur.- Will finish up Ignatia cure. It will nerve her up help her to bear her sufferings. It is the natural chronic of Ignatia. When the troubles keep coming back, and Ignatia comes to a place when it will not hold any longer.
Lachesis.- Cloudy state, sadness, melancholy, with sorrows from head to foot. < Warm bath sleep.
Pulsatilla.- Melancholia ; sadness, weeping, despair, extremely touchy mild gentle tearful.
Boericke 4 1 :- Recommends remediesMelancholia : First Grade - Alum, Aur, Cimi, etc.Melancholia, despondent, depressed, low spirited, gloomy- Alum,
Anac, Aur, China, Cimic, Graph, Ign, Lil.tig, Nat.m Nux, Phos, Plat, Plb, Puls, Sep, Sil, etc.
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METHODOLOGY
1. The present study consisted 30 patients of depression, who
attended my clinic during the period of 29-10-2003 to 31-03-2005.
2. The 30 cases of depression were selected on the basis of inclusion
criteria, which all are females.
3. Females of reproductive age group were considered from menarche
to menopause, as per my studies highest number of patients seen
between 30-42 years age group.
4. The cases were recorded keeping the Holistic and individualistic
concept in mind.
5. Case taking was done according to the scheme of model case paper
(Appendix-I) with a special emphasis to ascertain the following
points.
a. Mode of presentation of the disease: All the symptoms presented
by different patients have been recorded in every case in
chronological order.
b. History of present complaints: The details of the present
complaints along with the onset, duration have been recorded with a
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special emphasis to the family stressors pertaining to the present,
complaints along with concomitants.
c. Past History: History of similar complaints and their treatment was
recorded. Any other complaints were recorded in chronological order
with the nature, treatment and results or treatment to understand
miasmatic cleavage.
d. Family History: Detailed family history was taken to find the
incidence of similar complaints or any other acute / chronic disease
in the family to evaluate the miasmatic background and inherited in
the family. (Types of Family & Family Dynamics)
e. Personal History: All the generalit ies of the patients to relate the
patient as a whole were recorded with a special emphasis to thermals,
mental reactions, aversion, desires aggravation with food and food
habits, appetite, thirst, bowels, perspiration, sleep, dreams. Female
menstrual history, finding and observation and examination.
f. General physical examination: The positive findings of built
nourishment and vital data were recorded and all other details to
assess constitution of persons.
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g. Systemic examination: The positive findings were noted.
h. Investigations:
Blood routine: Hb%, TG, DC, ESR, Peripheral smear was carried out in
most of the cases.
Urine routine: For sugar, albumin and microscopic examination of the
urine sample was carried out in many cases.
Diagnosis: Diagnosis of depression where made on following points.
a) Basic and absolute manifestation with determinative
symptoms of the disease. (As per ICD-10 Classification of
Mental disorder) and Criteria for major depressive episode
(Source – Diagnostic and Statistical manual of Mental
disorder, 4 t h edition).
b) Determinative symptoms of an individual on the basis of
totality of symptoms.
i) General Management:
1. Counseling patient and family.
2. Brief advice on coping with depression.
3. Fast moves to download stress.
4. Keep family atmosphere healthy. ci
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5. Regular exercise / relaxing techniques
6. Yoga
7. Nutritious
8. Balance diet
6. Steps for Homoeopathic Prescription:
a) The cases were analyzed and evaluated according to Kertanian
method.
b) Repertorisation:
Kent’s repertory was used where prime importance was given
to:
1) Mental Generals
2) Physical generals (including modalities) to the
2 n d stage.
3) Characterist ic particular were considered for repertorisation.
Computer repertorisation was done in all the cases.
c) Miasmatic diagnosis: Analyzed symptoms were repertorised
using the Dr. R.P. Patel’s “The Repertory of Miasms”.
d) Selection of remedy was done on the basis of repetorial results,
characteristic symptoms and miasmatic diagnosis of the patient.
e) Complementary Remedy: was used when indicated remedy gave
relief to some extent and failed to bring disorder deep seated,
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another remedies that was cognate of the indicated remedy and
more deep acting was prescribed.
d) Intercurrent remedy: Intercurrent remedy was given when the
miasmatic block was suspected, when indicated remedy, which
was tried in various potencies and with appropriate repetit ion.
e) Constitutional Medicines: Ghatak states, the difference between
acute and chronic prescription is that in chronic the medicine has
to be miasmatic while in acute it need not to be so. The medicine
indicated by the totali ty of the symptoms of the miasm
predominant will have to be selected and not the medicine
indicated by the totali ty of the symptoms of the whole care. In
brief the prescription must be miasmatic constitutional medicines
were selected on the basis of totali ty of symptoms and reportorial
results after repertorisation.
f) Potency and Repetition: Indicated remedy was prescribed in
200 t h potency in the beginning. It was reported depending on the
severity of the complaints higher potencies were administered
after the first potencies to give relief depending upon the merit of
the case.
7. All the cases were revived once in 7 days for the first two
months, then once in 15 days for the first two months and latter
every 30 days for the remaining period of study or as per the
demand of the case and the progress was recorded.
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8. The following parameters were fixed according to the type of
response obtained after treatment and these criteria should be
fulfilled for at least 6-12 months.
a) Improved: Patient has showed remarkable positive response to
the treatment and completely rid of sufferings for a
considerable period. Patients who was very happy and didn’t
return.
b) Not Improved: Initial response, no response, no reduction of
frequency / reduction of complaints even after defined period
of treatment.
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SYNOPSIS OF CASES
1. The patient name Mrs. K.G. aged 38 years, presented with
depressed mood, loss of interest in work. Suicidal thoughts was
diagnosed as recurrent mild depression. She had also had
Epigastric pain flatulency. She had past history of depression,
family history says. Father suffered from Eczema, miasmatic
diagnosis was psora. Base on all above data and other general
characteristic symptoms chilly, dread of animals, suicidal thoughts
but lack of courage. Aversion fish CHINA was given as
constitutional medicine there was remarkable improvement in
patient.
2. The patient named Mrs. R.M. aged 30 years presented with sad
mood, hopelessness, helplessness. Diagnosed as recurrent mild
depression. She had past history of depression and family history
says mother suffering with depression. The miasmatic diagnosis
was psora. Base on above data and other general characteristics
like. Long involuntary sighing, desire for onions, desire for bread,
aversion to milk, consolation aggravates complaints, talks more
when sad. Ignatia was selected as a constitutional remedy. There
was slight improvement. NAT.MUR was given as complementary
remedy. There was remarkable improvement.
3. The patient named Mrs.H.M. aged 29 years sad weeping mood
whole day she was diagnosed as cases of mild depression. She had
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also had cough with expectoration. She had past history of
repeated cold. Her family history shows mother suffered from
Gastritis. The miasmatic diagnosis was psora. Based on above data
and general characteristics on Ambithermol weak look, offensive
perspiration, cough better expectoration, cough waste night, warm
drinks, talking, laughing, singing, feels crying all the time.
Sadness before menses STANNUM.MET was given as
constitutional remedy patient showed tremendous improvement.
4. The patient named Mrs.A.B. age 40 years presented complaints of
sad mood, melancholy was diagnosed as recurrent mild
depression. The other complaints where menstrual irregularity.
Her past history showed depressive episodes. She presented family
history, where mother suffered from hypertension. Miasmatic
background was Psora. Considering above data and general
characteristic symptoms as Hot patient, jealous, C/F long lasting
grief, greedy nature, complaints better menstrual flow, more sad
after sleep. LACHESIS was selected as constitutional remedy.
Patient showed much improvement, episode reduced.
5. The patient named Mrs. P.C. presented with weeping sad mood
was diagnosed as recurrent mild depression. Other complaints
were headache. Past history showed depressive episodes. She had
family history father suffered with Eczema. The miasmatic was
Psoro-sycosis. Base on above data and general characteristic
symptoms as Ambithermal, mild nature, fear of darkness, highly
emotional, desire consolation, weeping disposition thoughts of
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death. PULSATILLA was selected as constitutional remedy. Patient
showed remarkable improvement. Episodes reduced.
6. The patient name Mrs.C.S. aged 39 years presented with sad mood
persistent melancholy was diagnosed as persistent mild
depression. The other complaints were headache. Past history of
depressive mood and family history showed, mother suffered from
CCF. The miasmatic diagnosis was psora-sycosis-syphilis. Based
on above data and characterist ic symptoms as Chilly nervous,
temperature. Desire to cause, despair, forgetful, proud, adamant,
constantly thinking past thing. NITRIC.ACID was selected as she
had very stubborn nature, adamant. Proud not regular in treatment,
didn’t showed improvement.
7. The patient name Mrs.I.M. aged 30 year presented complaints of
sad mood, lack of interest in work was diagnosed as recurrent mild
depression. She had secondary sterility with past history of
depression, abortion. Family history showed maternal grandmother
suffered from Hypertension. The miasmatic diagnosis was psor-
sycosis. Based on above data and characteristic symptoms as
tendency for abortion, early menarche, aversion to music, C/F
grief. SABINA was selected as constitutional remedy. Case shown
good improvement.
8. The patient named Mrs.A.M. aged 39 years presents with
complaints of sad mood. Despair melancholy. Diagnosed as
recurrent moderate depression. Also had menstrual irregularity
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skin eruption. Her past history showed skin eruptions, depression.
Family history mother suffered from depression. The miasmatic
diagnosis was psoric. From the above data and general
characteristics as sees darkness around with helplessness,
offensive menstrual flow and perspiration, better perspiration.
PSOR.NUM was selected as a constitutional remedy. SULPHUR
was given as complementary remedy patient showed tremendous
improvement.
9. The patient name Mrs. K.H. aged 35 years presented complaints of
sadness and weeping disposition. The other complaints were
apthous ulcers. The case was diagnosed as mild depression. The
past history showed repeated attacks of apthous ulcers, menstrual
irregularity. The family history showed. Mother suffering from
Schizophrenia. The miasmatic diagnosis was psoro-syphilis. Based
on above data and general characterist ics as disgust for life, A/F
fear, coated tongue, offensive breath, bitter taste. MERC.SOL was
selected as a constitutional remedy patient showed tremendous
improvement.
10. The patient named Mrs. N.M. aged 25 years presented with
complaints of depressed sad mood. The other complaints where
dandruff. The case was diagnosed as recurrent moderate
depression. The past history showed menstrual irregularity,
depression. Family history showed father suffered from diabetes.
The miasmatic diagnosis was psoro-syco-syphilis. Base on above
data general characteristics as suicidal thoughts, unwilling to talk,
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as work slow, fear of darkness, thinking slow, frightened,
intermittent menstrual flow. General and characteristics
PHOSPORUS was selected as constitutional remedy patient
showed good improvement.
11. The patient named Miss. S.M. Aged 16 years presented with
complaints of sad weeping mood. The other complaints were
headache. The case was diagnosed as recurrent moderate
depression and the past history showed G. Seizers, menstrual
irregularity, depression. Family history showed mother suffered
with Epilepsy. The miasmatic diagnosis was psora. Based on
above data and general characterist ics as C/F long standing mental
exertion, easily angered, wants to die but afraid to die, desire
fruits, aversion vegetables, hungry but dislikes food, cries in
sleep. NUX.VOMICA was selected as constitutional remedy.
Patient showed tremendous improvement.
12. The patient named Mrs. M.G. Aged 30 years sadness
weakness. The other complaints were constipation. The case was
diagnosed as mild depression. The passed history showed cold and
coryza. The family history showed mother suffered with Epilepsy.
The miasmatic diagnosis was Psoric. Based on above data and
general characteristic as timid, involuntary sighing, desire fruits,
aversion milk, ambithermal, emotional C/F coffee as constipation.
Shy nature IGNATIA was selected as constitutional remedy.
Patient showed good improvement.
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13. The patient named Mrs.F.S. aged 30 years presented with
complaints of sad mood weeping disposition in recurrent episode.
The other complaints were headache. The case was diagnosed as
recurrent mild depression. The past history showed history of
abortions. The family history showed maternal uncle suffered with
diabetes mellitus. The miasmatic diagnosis was psoric. Based on
above data and general characterist ics as chilly, headache < heat
of sun, C/F disappointment of love, aversion milk, suicidal
thoughts. NATRUM.CARB was selected as constitutional remedy.
Patient showed tremendous improvement. Episode not repeated.
14. The patient named Mrs.S.S. aged 38 years. Presented with
sad mood, lack of interest suicidal thoughts repeatedly. The other
complaints were fullness of abdomen flatulency. The case was
diagnosed as recurrent mild depression. The past history showed
depression and undergone thyroidectomy. The family history
showed mother suffered from depression. The miasmatic diagnosis
was psoric. From the above data and general and characteristics as
Robust but weak lady, sensitive to cold, suicidal thoughts but lack
of courage, desire sour things, C/F mental emotions. CHINA was
selected as constitutional remedy. Recurrent episodes were
reduced patient showed good improvement.
15. The patient named Mrs.C.N. aged 42 years presented with
sadness. Hopelessness, worthlessness, suicidal thoughts. The other
complaints where disturbed sleep. The case was diagnosed as
recurrent mild depression. The past history showed depression.
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The family history showed mother suffered from diabetes mellitus.
The miasmatic diagnosis was psoro-syco-syphilitic. Base on above
data and general characteristics as C/F loss of dearest one (son),
loss sleep, selfishness, unsympathy, rude, depression < evening,
sadness before menses. NITRIC. ACID was selected as a
constitutional remedy. In 6 months only once the episode was
repeated initially with in 3 months later episode not repeated the
patient showed good improvement.
16. The patient named Mrs.S.E. aged 30 years presented with
sad mood lack of interest in mental and physical work in repeated
episodes. The other complaints were reduced appetite. The case
was diagnosed as recurrent mild depression. The passed history
showed H/O depression and malaria. The family history showed
mother suffered from Goiter. The miasmatic diagnosis was psora.
Base on above data and general characteristics as excess tea
drinker, C/F loss sleep, mental emotion, anaemic P/A of malaria.
CHINA was selected as an constitutional remedy. Episode not
repeated patient showed tremendous improvement.
17. The patient named Mrs.M.S. aged 25 years presented with
sadness. The other complaints were leucorrhoea. She was
diagnosed as a case of mild depression. The past history was
suffered from cold and coryza. Her family history showed mother
suffered from gastritis. The miasmatic diagnosis was psora. Base
on above data and general characterist ic symptoms as C/F fear,
weeping wants to weep all the time, sadness before menses,
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mentals better menstrual flow. STANNUM.MET was selected as
constitutional remedy. There was a remarkable improvement.
18. The patient named Mrs.P.T. aged 38 years presented with
sadness, melancholic mood. The other complaints were
constipation. She was diagnosed as a case of mild depression. Her
past history showed repeated attack of cold / constipation. Her
family history showed mother suffered from depression. The
miasmatic diagnosis was psora. From the above data and general
characteristics as chilly, habitual constipation. Constipation better
hot milk, constantly remedies past events, music makes any
hesitation in decision. GRAPHITES was selected as constitutional
remedy. Patients showed tremendous improvement.
19. The patient named Miss.N.D. aged 19 years presented with
sadness, continuous weeping disposition, her other complaints
were headache. The case was diagnosed as recurrent mild
depression. Her past history showed repeated attack of cold.
Family history sister suffering with gastritis. The miasmatic
diagnosis was psora. Based on above data and general
characteristic as C/F fear, feeling shame, weeping disposition,
timid. IGNATIA was selected as constitutional remedy. Patient
didn’t showed improvement and discontinued.
20. The patient named Mrs.B.M. aged 42 years case with
complaints of sad mood, suicidal thoughts, melancholy. The other
complaints were headache. The case was diagnosed as mild
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depression. Her past history showed repeated attack of headache.
Family history mother suffered from C.C.F. The miasmatic
diagnosis was psoro-syco-syphilis. Base on above data and general
characteristics as hot yet catches cold easily, C/F bad effects of
anger. Constantly recalls unpleasant occurrence, craving for fish,
milk, aversion, bread. NAT.MUR was selected as constitutional
remedy patient showed tremendous improvement.
21. The patient named Miss.G.N. aged 32 years case with the
complaints on sad mood, weeping disposition. The other
complaints were headache. The case was diagnosed as mild
depression. Past history showed repeated cold and coryza. Family
history father suffered from Hypertension. The miasmatic
diagnosis was psoro-sycosis. From the above data and general
characteristics as tall, slim, nervous lady, aversion towards men,
frequent attacks of weeping, consolation aggravates. SEPIA was
selected as constitutional remedy. Patient showed tremendous
improvement.
22. The patient named Mrs.N.M. aged 30 years case with
complaints of sad weeping mood the other complaints were
constipation. The case was diagnosed as recurrent moderate
depression. Had past history of cold, depression. Family history
maternal grandmother suffered from Arthritis. The miasmatic
diagnosis was psoric. Based on above data and general
characteristics as wants to feel like crying but cannot cry,
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constipated, hard, knatty, despair of life. AMMNIUM.MUR was
selected as a constitutional remedy. The patient improved a lot.
23. The patient named Miss. A.M. aged 18 years presented with
complaints of sad and weeping mood. The other complaints was
headache. She was diagnosed as a case of mild depression. The
past history showed cold and coryza. The family history showed
mother suffered hypertension and maternal grandmother Anaemia.
The miasmatic diagnosis was psoro-syco-syphilis. From the above
data and general and characteristic symptoms as sensitive to all
impressions, chilly yet desires cold drinks, sweating in palms
which is offensive. SILICEA was selected as a constitutional
remedy. PULSATILLA was given as complementary remedy. The
patient showed good improvement.
24. The patient named Mrs.K.G. aged 21 years case with
complaints of sad, waste of interest mood. The other complaint
was headache. The case was diagnosed as persistent mild
depression. The past history showed depression. Family history
nothing significant. The miasmatic diagnosis was Syphili tic.
Based on above data and general and characterist ics as C/F
disappointment, suicidal thoughts, cannot do any work fast, self
condemnation. AURUM.MET was selected as constitutional
remedy. SYPHILINUM was given as complementary remedy.
Patient discontinued treatment.
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25. The patient named Mrs.S.G. aged 30 years came with
complaints of sad weeping mood. The other complaint was
headache. The case was diagnosed as mild depression. The past
history showed repeated attack of headache. Family history father
suffered from Arthritis. The miasmatic diagnosis was psora-syco-
syphilis. From the above data and general and characteristic
symptoms as aversion to people thinks offended her, headache
every 2 weeks, dreams full of sorrows, thirsty. ARSENIC.ALB
was selected as constitutional remedy. Patient discontinued.
26. The patient named Mrs.R.G. aged 42 years came with
complaints of sad mood, the other complaint was skin eruptions.
The case was diagnosed as mild depression. The past history
showed skin eruptions. The family history showed mother suffered
with diabetes mellitus. The miasmatic diagnosis was psora. Based
on above data and general and characteristics symptoms as
indolent, craving for sweets, aversion meat, itching of skin late
night. SULPHUR was selected as constitutional remedy.
TUBERCULINUM was given intercurrent remedy. Patient showed
tremendous improvement.
27. The patient named Miss.M.G. aged 18 came with
complaints of depressed mood. The other complaint was
constipation. She was diagnosed as a case of mild depression. The
past history showed repeated attack of cold and coryza. The family
history father suffered from Eczema. The miasmatic diagnosis was
psora. Based on above data and general and characteristic as over
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Homoeopathic Review
sensitivness and irritabili ty. NUX.VOMICA was given as
constitutional remedy. Patient showed tremendous improvements.
28. The patient named Miss.L.G. aged 18 years came with
complaints of depressed mood. The other complaint was dry skin
eruption. The case was diagnosed as recurrent moderate
depression. The past history showed dry skin eruptions,
depression. Family history, maternal grandfather suffered from
Arthritis. The miasmatic diagnosis was psora. Based on above data
general and characteristic symptoms as female with offensive body
odour, makes our life and around her miserable, skin eruptions
every winter. PSORINUM was given as constitutional remedy.
SULPHUR was given as intercurrent remedy. Patient showed
tremendous improvement.
29. The patient named Mrs.S.G. aged 38 years came with
complaints of depressed mood, the other complaint was headache.
She was diagnosed as recurrent mild depression. The past history
showed repeated attack of cold and coryza. Family history mother
suffered from depression. The miasmatic diagnosis was psora.
Based on above data general and characteristics, as music makes
her weep, thinking causes headache. Strong aversion to milk.
NATRUM.CARB was selected as constitutional remedy. Patient
showed good improvement.
30. The patient named Mrs.G.B. aged 32 years presented with
complaints of sad, depressed mood. The complaint was headache.
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Homoeopathic Review
She was diagnosed as a case of mild depression. The family
history showed mother suffered from Gastritis. The miasmatic
diagnosis was psora. Based on above data, general and
characteristic symptoms as shy nature, timid, involuntary sighing
indifferent, wants to be alone, disturbed by slightest emotions.
IGNATIA was given as constitutional remedy. The patient showed
tremendous improvement.
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Homoeopathic Review
SUMMARY
30 cases of Depression in Females from menarche to menopause. That is Reproductive age group, which satisfied the inclusive and exclusive criteria, were considered to study the response of Homoeopathic management in depression I present the list of my entire studies in the following points.
1) The most age of incidence of depression in Female which family stressors was found common between 31 to menopause.
2) As depression more common in Females my 30 cases study was only on female which met inclusive criteria.
3) Maximum No. of Females were from rural area.
4) Maximum Females where non- working women.
5) The most commonly affected Female where from Joint Families,
because of unnecessary tortures and spoiled relations with in laws,
spouse etc.,
6) Most common sufferers were low socio- economic group of
Females.
7) Uneducated females are common sufferers.
8) Commonly seen precipitating factors was negative thinking, lack
of confidence, lack of scope to express their feelings.
9) Common sufferers were females who’s relations disturbed with
spouse, in-laws, widows, divorces.
10) The most common past history were found to be depression, cold
and coryza, menstrual disorder, skin complaints, headache, abortion.
11) The most common family history to be found way Gastritis,
Depression, Joint complaints, skin disorders, Hypertension, Diabetes
Mellitus.
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Homoeopathic Review
12) Most of the cases were mild and recurrent mild depression others
recurrent moderate & persistent mild depression.
13) The miasmatic background of most of the cases was found to be
psoric (predominant miasm) and few cases all 3 miasm. Hence it may be
safely concluded that depression covers all three miasm.
14) Most commonly used constitutional remedies where China,
Ignatia, Stann.Met, Nit acid, Psorinum, Nux.V, Nat.Carb other
constitutional remedies used where Lach, Puls, Sabina, Mer.Sol, Phos,
Graph. sili, Aur.Met, Ars, Sulp, Nat.Mur, Sil, Amm.Mur.
15) The intercurrent remedies used were Sulphur and Tuberculinm.
16) The complementary remedies used were Puls, Syphil, Nat.Mur and
Sulphur.
17) It was found that even in spite of family stressors. Finally were
able to able to cope up with problems with positive thinking tolerance
and courage.
18) It was found that the severity, frequency and recurrence
(episodes) of the complaints were reduce with help of Homoeopathic
Medication.
19) This was the time bound study, therefore could not follow the
cases for longer period.
20) In the treatment counseling and psychotherapy played a important
role.
21) In the studies potency used was 200 to 10M. 1 M was the most
commonly used potency. Most important part of prescription was
Placebo helped tremendously in all the cases.
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Homoeopathic Review
DISCUSSION
Depression is one of the most common disorder, which is recurrent
sometimes persistent has multiple somatic complaints requires medical
affection. This disorder is outcome of changed living life styles. Effects
of stressful life condition, worries which often follow chronic
progressive interferes the routine activit ies of the patient. Present
literature, which has explained its importance and management of such
disorder needs, a detailed study for further understanding and better
management by Homoeopathy.
The present study was carried out in 30 cases that fitted into the
inclusion criteria, to study the Homoeopathic management of this
condition.
As per the tables:
1) Age Incidence: The highest incidence was seen in age group of 30-
menopause years. Age group between menarche-20 were 16.67%
cases, 21-30 were 33.33% and 31-menopause i.e., 50%. The
youngest age of the patient is 18 years and oldest 42 years.
2) Urban and Rural Area Females: The study showed the maximum
number of patients where from rural area that is 18 patient, 60%
remaining 12 patients i.e., 40%.
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Homoeopathic Review
3) Occupation: The study showed maximum number of patients were
non-working women i.e., 20 cases, 66.67% and remaining 10 cases
33.33% working women.
4) Family: The study showed maximum number of females from joint
family i.e., 18 cases 60% and remaining 12 cases nuclear family 12
cases i.e., 40%.
5) Socio-Economical Background: From the study it is seen that most
of the patient is from low socio-economic group and not well to do
family. 20 cases 66.67% remaining 10 cases good socio-economic
condition i.e., 33.33% dependency rate is increased.
6) Education: The study showed maximum females were uneducated
17 cases i.e., 56.67% and 13 cases educated females i.e., 43.33%.
7) Type of Marriage: The study showed maximum number of females
of arrange marriage i.e., 76.67%, love marriage 6 cases i.e., 20%
and love cum arrange marriage 1 case 3.33%.
8) Marital relations: The study showed maximum number of females
whose relations disturbed with spouse 8 cases i.e., 26.66%, widows
and divorcees 5 cases each i.e., 16.67% and relations good with
spouse with other problems 6 cases i.e., 20% and unmarried 6 cases
i.e., 20%.
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Homoeopathic Review
9) Past History: The study showed depression 11 cases i.e., 36.66%,
cold and coryza 9 cases i.e., 30%, menstrual disorder and skin
complaints 3 cases each i.e., 10%, abortion and headache 2 cases
each i.e., 6.67%.
10) Family history: Miller 4 3 1993 says, “In many old standing
chronic cases, especially those that have been long under allopathic
treatment, these peculiar and characteristic symptoms have so
completely disappeared, or have been so utterly forgotten, that
difficulties are thereby increased. May, it is even the case at times
that the characterist ics symptoms may never have existed except in
the patients ancestors and under these circumstances cure is
practically impossible.
The study showed that family history of depression 13.33%,
mental disorder 3.33%, heart diseases, 6.67%, skin disorders
13.33%, epilepsy 3.33% hypertension 13.33%, diabetes 13.33%.
11) Miasmatic Background: It has been observed than study showed
Psora is the background for 19 cases 63.33%, Sycosis –10 33.33%,
Syphilitic 2 6.67% psora-sycosis 6.67%, all 3 miasms 6.20%.
According to Ortega 1980 2 4 , “The miasms are always
mixed together in the individual, so that even when his attitude and
appearance. Correspond more to one of these fundamental
modulations, he will still inevitably contain traits and some or more
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Homoeopathic Review
manifestations of the other two, although at each stage of his life
one of the three – psora, sycosis or syphilis will dominate.
12) Constitutional Remedies: Orgeta 4 4 1989, tells us: “The actual
sickness presented by the patients should not be viewed as a
separate from its vital antecedents, but rather as a metastasis aspect
of a morbid situation; it stands out like a wave of greater or lesser
magnitude against the constitutional background….. dyscrasic or
diathesis states which condition the emergence of sicknesses or
syndromes, each of the latter being erroneously regarded as a
separate and independent clinical entity …. Morbid alterations of
the individual and thus affects his genotype…. Which can be
considered constitutional illnesses, that distinguish one human from
others”.
According to Garth Boericke 3 1 , “All treatment of difficult
cases is constitutional, and it has been found that a certain class of
remedies is best for this purpose. Such drugs profoundly affect
metabolism and physidogic process, in contradiction to the more
superficial remedies whose sphere is functional change and whose
action is comparatively short. Constitutional treatment is never
taken at bedside but only after a most exhaustive examination, with
due regards to history, physical examination and laboratory
finding”.
Constitutional medicines were selected on the basis of
totali ty of symptoms and reportorial results after repertorization
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Homoeopathic Review
with the Kent’s repertory and Dr.R.P. Patel’s repertory of chronic
miasms.
The constitutional medicines used for the treatment for 30
cases. Ignatia was used frequently indicated remedy i.e. 13.33%,
china was indicated as constitutional remedy in 3 cases that is 10%,
stann.met, Nit.Acid, Psorinum, Nux.vom, N.Carb were indicated as
a constitutional remedies in 2 cases each i.e. 6.67%. Following
Lach, Puls, Sabina, Mersol, Phos, Grap, Silicea, Aur.met, Arsenic,
Sulp, N.Mur, Sepia, Amnon.Mur (1) cases each i.e. 3.33%.
By giving constitutional treatment patients are saved from
recurrent attacks, complications and side effects caused by
allopathic medicines. Females developed positive attitude to face
problems of life.
13) Complementary Remedies: Boreike, Garth 3 1 1994 writes in A
compared of the principles of Homoeopathy for students in
medicines as,
Complementary relationship is same what similar in as much
as they must be compatible, but here work done by one remedy is
completed by another complementary action.
Out of 30 cases only 4 patients required complementary
remedies, 1case of each i.e. Pulsatilla 3.33%, Syphillinum 3.33%,
Nat.Mur 3.33% and Sulp 3.33% as complementary remedies.
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Homoeopathic Review
14) Intercurrent Remedy: Otto Lesser 3 3 opines “Sulphur is
indicated by the special symptoms of the single case or occasionally
if it is used as an interpolated remedy when the reaction to another
correctly chosen remedy is insufficient.
30 cases were taken up for study to analyze the intercurrent
remedies used during the course of treatment. Out of 30 cases 2
cases were required intercurrent remedies. Sulp and Tuberculinum
each 3.33%.
15) Result of treatment: In this study, it was seen that 86.66% (26)
cases showed good improvement with Homoeopathic medications.
6.67% (2) cases failed to show the desirable improvement and 6.67
(2) cases discontinued in between. This percentage of improvement
was because Homoeopathic medicines along with councelling and
rehabili tation and general management as nothing else can bring out
such a tremendous result.
It is well known fact that the conventional mode of
treatment, apart from treating the presenting complaints produces
other distressing symptoms. But this is not observed in our
homoeopathic mode of treatment and also in the present study.
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CONCLUSION
I arrived at the conclusion that Homoeopathic Management of
Depression in females with family stressors along with counseling
and psychotherapy has shown tremendous result in most of the
cases taken for my study.
After prescribing indicated remedy patient started improving
mentally and physically, as the prescribed remedy has reduced
episodes, unnecessary imaginative process come unnecessary in
mind.
Hence she started feeling better, sense of well being is also
followed by.
Indicated Homoeopathic remedy after prescribing created
awareness to the patient that she is unnecessarily over reacting to
the situation around her, and also Homoeopathic indicated
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Homoeopathic Review
remedies will minimize negative reactions to all exposures like
mental stress.
The Homoeopathic medicines seems to be efficacious in
reducing recurrence and bring about significant improvement.
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